Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 4301044139 | MI |
Y | 208600000X | Surgeon | 4301044139 | MI |
NPI | 1003877481 |
---|---|
Provider Name | Pongchayut Surapipith |
First Address | Flint, MI 48503-4968 |
Second Address | Flint, MI 48532-3638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0202510851 | BLUE CROSS BLUE SHIELD (01) | MI |
1008625 | HEALTH ADVANTAGE (01) | MI |
1008625 | MCLAREN HEALTH PLAN (01) | MI |
4525121 | (05) | MI |
4735595 | (05) | MI |
A78286 | (02) | MI |
A78286 | HEALTH NET FEDERAL SERVIC (01) | MI |