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NPI Code Detail

MEDICARE: PICHAYA SARASOMBATH RATARASARN M.D.

MEDICARE: PICHAYA SARASOMBATH RATARASARN 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
1207N00000XDermatology Physician48712-020WI

General Provider Information

NPI Number : 1225095466
Entity Type Code : Individual
Provider Name (Legal Business Name) : PICHAYA SARASOMBATH RATARASARN M.D.
Provider Business Mailing Address
First Line : 3700 PARMENTER ST APT 205
Second Line :
City : MIDDLETON
State : WI
Zip : 53562-1537
Country : US
Telephone Number : 414-243-2999
Fax Number :
Provider Business Practice Location Address
First Line : 3051 CAHILL MAIN
Second Line :
City : FITCHBURG
State : WI
Zip : 53711-7109
Country : US
Telephone Number : 608-661-7200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2006
Last Update Date : 04/11/2017

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