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NPI Code Detail

MEDICARE: NUTTHA UNGNAPATANIN M.D.

MEDICARE:   NUTTHA  UNGNAPATANIN  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
1207R00000XInternal Medicine Physician125-052-303IL
2207RE0101XEndocrinology, Diabetes & Metabolism PhysicianE7591AR

Other Identifiers

General Provider Information

NPI Number : 1467610758
Entity Type Code : Individual
Provider Name (Legal Business Name) : NUTTHA UNGNAPATANIN M.D.
Provider Business Mailing Address
First Line : PO BOX 2319
Second Line :
City : ATLANTA
State : GA
Zip : 30301-2319
Country : US
Telephone Number : 479-709-7399
Fax Number : 479-709-7053
Provider Business Practice Location Address
First Line : 4700 KELLEY HWY
Second Line :
City : FORT SMITH
State : AR
Zip : 72904-5024
Country : US
Telephone Number : 479-709-7460
Fax Number : 479-573-7991
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2008
Last Update Date : 11/20/2012

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