Provider Demographics
NPI:1285678995
Name:THIHA, SAN HTUT (MD)
Entity Type:Individual
Prefix:
First Name:SAN
Middle Name:HTUT
Last Name:THIHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 MCLEOD ST
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3532
Mailing Address - Country:US
Mailing Address - Phone:321-452-2016
Mailing Address - Fax:321-452-5728
Practice Address - Street 1:45 MCLEOD ST
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3532
Practice Address - Country:US
Practice Address - Phone:321-452-2016
Practice Address - Fax:321-452-5728
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95764207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275260300Medicaid
FL275260300Medicaid