MEDICARE: DR. TASANAPORN PITIYANUVATH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	33971	MO
2	208000000X	Pediatrics Physician	33971	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225067945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TASANAPORN PITIYANUVATH M.D.

Provider Business Mailing Address
First Line	:	2340 E MEYER BLVD STE 200
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64132-1121
Country	:	US
Telephone Number	:	816-753-5144
Fax Number	:	816-777-2796

Provider Business Practice Location Address
First Line	:	2340 E MEYER BLVD STE 200
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64132-1121
Country	:	US
Telephone Number	:	816-753-5144
Fax Number	:	816-777-2796

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/26/2021

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