| Doctor Name: | MR. PERMSAKDI VADHANASINDHU |
| NPI Number: | 1942305875 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 036078060 |
| Business Practice Address: | 811 North Bloomington Street Streator, IL - 613642077 |
| Business Phone Number: | 8156727778 |
| Business Fax Number: | 8156720125 |
| Mailing Address: | Po Box 564, 811 North Bloomington Street STREATOR |
| State: | IL |
| Postal Code: | 613642077 |
| Phone Number: | 8156727778 |
| Fax Number: | 8156720125 |
| NPI Enumeration Date: | 09/14/2006 |
| NPI Last Update Date: | 03/15/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 036078060 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |