MEDICARE: DR. PHUDHIPHORN THIENPRASIT M.D., PH.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	207T00000X	Neurological Surgery Physician	21230	MN

General Provider Information

NPI Number	:	1437151669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHUDHIPHORN THIENPRASIT M.D., PH.D

Provider Business Mailing Address
First Line	:	1675 BEAM AVE
Second Line	:	STE 215
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-1172
Country	:	US
Telephone Number	:	651-748-1461
Fax Number	:	651-777-1191

Provider Business Practice Location Address
First Line	:	1675 BEAM AVE
Second Line	:	STE 215
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-1172
Country	:	US
Telephone Number	:	651-748-1461
Fax Number	:	651-777-1191

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	12/05/2007

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