Provider Demographics
NPI:1346545282
Name:RACHANAKUL, THUNTANAT (MD)
Entity Type:Individual
Prefix:DR
First Name:THUNTANAT
Middle Name:
Last Name:RACHANAKUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JEERASAK
Other - Middle Name:
Other - Last Name:RACHANAKUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13878 HEANEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7528
Mailing Address - Country:US
Mailing Address - Phone:732-610-5905
Mailing Address - Fax:
Practice Address - Street 1:300 S PARK RD
Practice Address - Street 2:SUITE 400
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8593
Practice Address - Country:US
Practice Address - Phone:954-981-6383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2015-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110066207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine