Provider Demographics
NPI:1558335893
Name:SAKBUN, VANNARA (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:VANNARA
Middle Name:
Last Name:SAKBUN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 E SPRINGHILL DR
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4448
Mailing Address - Country:US
Mailing Address - Phone:812-478-9845
Mailing Address - Fax:812-478-2074
Practice Address - Street 1:611 E SPRINGHILL DR
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4448
Practice Address - Country:US
Practice Address - Phone:812-478-9845
Practice Address - Fax:812-478-2074
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043923A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200041000Medicaid
INP00285687OtherRAILROAD MEDICARE
IN200041000Medicaid
INP00285687OtherRAILROAD MEDICARE
ING13381Medicare UPIN
INM400059965Medicare PIN