Provider Demographics
NPI:1457628273
Name:K THEPVEERA MD PC
Entity Type:Organization
Organization Name:K THEPVEERA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIANGSAK
Authorized Official - Middle Name:
Authorized Official - Last Name:THEPVEERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-755-4438
Mailing Address - Street 1:1731 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5344
Mailing Address - Country:US
Mailing Address - Phone:989-755-4438
Mailing Address - Fax:989-755-4693
Practice Address - Street 1:1731 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5344
Practice Address - Country:US
Practice Address - Phone:989-755-4438
Practice Address - Fax:989-755-4693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKT032947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1329574Medicaid
MIA77229Medicare UPIN