MEDICARE: DR. KRUAWAN - PAKSAICHOL 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	207R00000X	Internal Medicine Physician	135912	NY

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	:	1417949686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRUAWAN - PAKSAICHOL M.D.

Provider Business Mailing Address
First Line	:	25555 149TH AVE
Second Line	:
City	:	ROSEDALE
State	:	NY
Zip	:	11422-2812
Country	:	US
Telephone Number	:	718-712-2849
Fax Number	:	718-922-3765

Provider Business Practice Location Address
First Line	:	123 PENNSYLVANIA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-2428
Country	:	US
Telephone Number	:	718-922-3765
Fax Number	:	718-922-3765

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	07/08/2007

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