MEDICARE: DR. NIKORN ARUNAKUL 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	208D00000X	General Practice Physician	ME27861	FL

General Provider Information

NPI Number	:	1699778886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIKORN ARUNAKUL M.D

Provider Business Mailing Address
First Line	:	4296 5TH AVENUE
Second Line	:
City	:	MARIANNA
State	:	FL
Zip	:	32446
Country	:	US
Telephone Number	:	850-482-2061
Fax Number	:	850-482-6617

Provider Business Practice Location Address
First Line	:	4296 5TH AVENUE
Second Line	:
City	:	MARIANNA
State	:	FL
Zip	:	32446
Country	:	US
Telephone Number	:	850-482-2061
Fax Number	:	850-482-6617

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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