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General NPI Number Information
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NPI Number | 1235572991
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Entity Type | Individual
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Provider Name | LALIDA CHUPATANAKUL MD
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Gender | Female
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Dates
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Enumeration Date | 04/12/2013
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Last Update Date | 09/21/2018
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Provider Practice Location Address
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Address Line | 3285 S VAL VISTA DR
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City | GILBERT
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State | AZ
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Zip | 85297
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Country | US
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Telephone | 480-397-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 3285 S VAL VISTA DR
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City | GILBERT
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State | AZ
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Zip | 85297-7000
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Country | US
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Telephone | 480-397-2800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 67552-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 67552-20
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 036139532
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036139532
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License Number State | IL
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