Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 35-093581 | OH |
N | 2084N0402X | Child Neurologist | A92768 | CA |
NPI | 1154501989 |
---|---|
Provider Name | Dararat Mingbunjerdsuk |
First Address | Euclid, OH 44117-1714 |
Second Address | Cleveland, OH 44106-1716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2007 |
Last Update Date | 16/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A869820 | (05) | CA |
00A869820 | MEDICARE (01) | CA |
1025735520001 | (05) | PA |
113678 | UPIN (01) | CA |
2995540 | (05) | OH |