MEDICARE: DR. PATOMPONG UNGPRASERT 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	207RR0500X	Rheumatology Physician	35.137116	OH

General Provider Information

NPI Number	:	1316234115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATOMPONG UNGPRASERT M.D.

Provider Business Mailing Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0725
Country	:	US
Telephone Number	:	216-444-3876
Fax Number	:	216-445-7569

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-1301
Country	:	US
Telephone Number	:	216-444-3876
Fax Number	:	216-445-7569

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

Provider Enumeration Date	:	06/30/2011
Last Update Date	:	12/13/2019

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