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NPI Code Detail

MEDICARE: SOMPOP SRISUWANANUKORN M.D.

MEDICARE: SOMPOP SRISUWANANUKORN 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
1207RP1001XPulmonary Disease Physician01030518IN
2207RC0200XCritical Care Medicine (Internal Medicine) Physician01030518IN

Other Identifiers

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

General Provider Information

NPI Number : 1467439828
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOMPOP SRISUWANANUKORN M.D.
Provider Business Mailing Address
First Line : 9201 CALUMET AVE
Second Line :
City : MUNSTER
State : IN
Zip : 46321-2807
Country : US
Telephone Number : 219-836-2022
Fax Number : 219-836-1072
Provider Business Practice Location Address
First Line : 2075 INDIANAPOLIS BLVD
Second Line :
City : WHITING
State : IN
Zip : 46394-1948
Country : US
Telephone Number : 219-659-7000
Fax Number : 219-659-9018
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2005
Last Update Date : 01/16/2015

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Directions to “ SOMPOP SRISUWANANUKORN M.D.” Practice Location

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