Provider Demographics
NPI:1629275870
Name:LIMPIPHIPHATN, DHAJPHONG (MD)
Entity Type:Individual
Prefix:
First Name:DHAJPHONG
Middle Name:
Last Name:LIMPIPHIPHATN
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 1:1145 STONEWOLF TRL
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-4510
Mailing Address - Country:US
Mailing Address - Phone:314-719-7056
Mailing Address - Fax:
Practice Address - Street 1:1145 STONEWOLF TRL
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-4510
Practice Address - Country:US
Practice Address - Phone:314-719-7056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5529208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOLICENSE NUMBEROtherR5529