Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | P24261 | MD |
N | 111NI0900X | Internist | P24261 | MD |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 57236 | WI |
NPI | 1063643195 |
---|---|
Provider Name | San Thida |
First Address | La Crosse, WI 54601-5429 |
Second Address | La Crosse, WI 54601-5429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2009 |
Last Update Date | 16/06/2014 |