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NPI Code Detail

MEDICARE: THANITA THONGTAN MD

MEDICARE: THANITA THONGTAN 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
1390200000XStudent in an Organized Health Care Education/Training ProgramTX
2207RG0100XGastroenterology Physician01095800AIN
3207R00000XInternal Medicine Physician01095800AIN
4390200000XStudent in an Organized Health Care Education/Training ProgramGA

General Provider Information

NPI Number : 1558926071
Entity Type Code : Individual
Provider Name (Legal Business Name) : THANITA THONGTAN MD
Provider Business Mailing Address
First Line : 5520 LEONARDO DA VINCI STE 100
Second Line :
City : EDINBURG
State : TX
Zip : 78539-1422
Country : US
Telephone Number : 956-362-3636
Fax Number :
Provider Business Practice Location Address
First Line : 550 S LANDMARK AVE
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-3239
Country : US
Telephone Number : 812-355-6900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2019
Last Update Date : 12/15/2025

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Directions to “ THANITA THONGTAN MD” Practice Location

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