Healthcare Provider Details

I. General information

NPI: 1417237116
Provider Name (Legal Business Name): SIRADA PANUPATTANAPONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

1055 OLD RIVER RD APT 435
CLEVELAND OH
44113-5801
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-5437
  • Fax:
Mailing address:
  • Phone: 646-363-1937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number131231
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: