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General NPI Number Information
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NPI Number | 1366650236
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Entity Type | Individual
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Provider Name | AKALUCK THATAYATIKOM MD
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Gender | Male
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 12/13/2021
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Provider Practice Location Address
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Address Line | 2501 N ORANGE AVE STE 586
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City | ORLANDO
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State | FL
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Zip | 32804-4603
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Country | US
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Telephone | 407-821-3545
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Fax | 407-821-3546
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Provider Business Mailing Address
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Address Line | 2501 N ORANGE AVE STE 586
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City | ORLANDO
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State | FL
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Zip | 32804-4603
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Country | US
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Telephone | 407-821-3545
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Fax | 407-821-3546
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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 | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number | 2006035310
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2080P0216X
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Taxonomy Name | Pediatric Rheumatology Physician
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License Number | ME114452
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License Number State | FL
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