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General NPI Number Information
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NPI Number | 1588896526
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Entity Type | Organization
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Legal Business Name | TASANAPORN PITIYANUVATH, M.D. L.L.C.
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Dates
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Enumeration Date | 08/09/2009
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Last Update Date | 05/22/2012
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Provider Practice Location Address
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Address Line | 6400 PROSPECT AVE SUITE # 208
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City | KANSAS CITY
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State | MO
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Zip | 64132-1100
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Country | US
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Telephone | 816-812-3512
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7862
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City | OVERLAND PARK
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State | KS
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Zip | 66207-0862
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Country | US
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Telephone | 816-812-3512
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TASANAPORN PITIYANUVATH
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Credential | M.D.
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Telephone | 816-812-3512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 33971
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License Number State | MO
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