Healthcare Provider Details

I. General information

NPI: 1427087188
Provider Name (Legal Business Name): TAVEEPONG TERAYANONT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 WASHINGTON AVE
EVANSVILLE IN
47714-0541
US

IV. Provider business mailing address

3700 WASHINGTON AVE
EVANSVILLE IN
47714-0542
US

V. Phone/Fax

Practice location:
  • Phone: 812-485-4994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number01056221A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: