Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0205X | Pediatric Endocrinologist | 2006035310 | MO |
Y | 2080P0216X | Pediatric Rheumatologist | ME114452 | FL |
NPI | 1366650236 |
---|---|
Provider Name | Dr. Akaluck Thatayatikom |
First Address | Orlando, FL 32804-4603 |
Second Address | Orlando, FL 32804-4603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 13/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007298300 | (05) | FL |