MEDICARE: DR. AKOM VUTPAKDI M.D.

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	2085R0202X	Diagnostic Radiology Physician	E0211	TX

General Provider Information

NPI Number	:	1295850568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AKOM VUTPAKDI M.D.

Provider Business Mailing Address
First Line	:	3018 SUTTON WOODS DR
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33566-9606
Country	:	US
Telephone Number	:	813-719-1677
Fax Number	:

Provider Business Practice Location Address
First Line	:	3018 SUTTON WOODS DR
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33566-9606
Country	:	US
Telephone Number	:	813-719-1677
Fax Number	:

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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