MEDICARE: SAKOLWAN SUCHARTLIKITWONG 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
1	207R00000X	Internal Medicine Physician	65103	AZ
2	207RG0100X	Gastroenterology Physician	65103	AZ

General Provider Information

NPI Number	:	1790136471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAKOLWAN SUCHARTLIKITWONG MD

Provider Business Mailing Address
First Line	:	1441 N 12TH ST FL 2
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2837
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 N 12TH ST FL 2
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2837
Country	:	US
Telephone Number	:	602-521-5180
Fax Number	:

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

Provider Enumeration Date	:	06/24/2016
Last Update Date	:	12/04/2025

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