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NPI Code Detail

MEDICARE: SUPORN PONGLORPISIT MD

MEDICARE: SUPORN PONGLORPISIT 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
1207P00000XEmergency Medicine Physician01039904AIN

General Provider Information

NPI Number : 1508843194
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUPORN PONGLORPISIT MD
Provider Business Mailing Address
First Line : 1808 SHERMAN DR
Second Line :
City : PRINCETON
State : IN
Zip : 47670-1043
Country : US
Telephone Number : 812-385-3401
Fax Number : 812-385-9249
Provider Business Practice Location Address
First Line : 1808 SHERMAN DR
Second Line :
City : PRINCETON
State : IN
Zip : 47670-1043
Country : US
Telephone Number : 812-385-3401
Fax Number : 812-385-9249
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2005
Last Update Date : 07/08/2007

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Directions to “ SUPORN PONGLORPISIT MD” Practice Location

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