Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 01073887A | IN |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 2013006646 | MO |
NPI | 1356547095 |
---|---|
Provider Name | Sakkapol Ongwijitwat |
First Address | Indianapolis, IN 46250-2890 |
Second Address | Indianapolis, IN 46250-2041 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2007 |
Last Update Date | 15/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201226670 | (05) | IN |
P01347726 | MEDICARE RR PTAN (01) | IN |