MEDICARE: DR. APICHAN POOTRAKUL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	13567	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114909967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. APICHAN POOTRAKUL MD

Provider Business Mailing Address
First Line	:	PO BOX 53568
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85072-3568
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13188 N 103RD DR
Second Line	:	STE. 206
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3064
Country	:	US
Telephone Number	:	623-972-3001
Fax Number	:	623-933-3045

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	10/06/2008

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