Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 38776 | IA |
N | 111NI0900X | Internist | 38776 | IA |
Y | 207RN0300X | Nephrologist | 38776 | IA |
NPI | 1063604726 |
---|---|
Provider Name | Kantima Phisitkul |
First Address | Dakota Dunes, SD 57049-5018 |
Second Address | Iowa City, IA 52242-1007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2007 |
Last Update Date | 03/07/2019 |