Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 36706 | IA |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 36706 | IA |
NPI | 1205090297 |
---|---|
Provider Name | Phinit Phisitkul |
First Address | Sioux City, IA 51104-3796 |
Second Address | Sioux City, IA 51104-3796 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2008 |
Last Update Date | 06/12/2018 |