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General NPI Number Information
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NPI Number | 1295231801
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Entity Type | Individual
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Provider Name | PANUMART MANATPON MD
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Gender | Female
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 08/10/2022
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Provider Practice Location Address
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Address Line | 200 E CHESTNUT ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-1831
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Country | US
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Telephone | 502-629-2880
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Fax |
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Provider Business Mailing Address
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Address Line | 888/67 GRAND DIAMOND PETCHBURI RD. RATCHETHEWI
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City | BANGKOK
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State | BANGKOK
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Zip | 10400
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Country | TH
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Telephone |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 56432
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License Number State | KY
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