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General NPI Number Information
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NPI Number | 1710094776
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Entity Type | Organization
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Legal Business Name | SITHIPOL TANTIHACHAI, MD, PC
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7794 RHEA COUNTY HWY MEDIVCAL PROFESSIONAL BUILDING, SUITE 102
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City | DAYTON
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State | TN
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Zip | 37321-5981
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Country | US
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Telephone | 423-775-6550
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Fax | 423-775-6689
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Provider Business Mailing Address
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Address Line | 7794 RHEA COUNTY HWY MEDIVCAL PROFESSIONAL BUILDING, SUITE 102
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City | DAYTON
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State | TN
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Zip | 37321-5981
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Country | US
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Telephone | 423-775-6550
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Fax | 423-775-6689
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Authorized Official
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Title or Position | OWNER
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Name | DR. SITHIPOL TANTIHACHAI
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Credential | MD
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Telephone | 423-775-6559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 13092
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License Number State | TN
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