Basic Information
| Provider Information | |||||||||
| NPI: | 1295231801 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANATPON | ||||||||
| FirstName: | PANUMART | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 888/67 GRAND DIAMOND PETCHBURI RD. RATCHETHEWI | ||||||||
| Address2: | |||||||||
| City: | BANGKOK | ||||||||
| State: | BANGKOK | ||||||||
| PostalCode: | 10400 | ||||||||
| CountryCode: | TH | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 E CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026292880 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2018 | ||||||||
| LastUpdateDate: | 08/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 56432 | KY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.