Provider Demographics
NPI:1689960346
Name:CHAYANUPATKUL, MANEERAT (MD)
Entity Type:Individual
Prefix:MISS
First Name:MANEERAT
Middle Name:
Last Name:CHAYANUPATKUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 MAIN ST
Mailing Address - Street 2:SUITE 11D32.5
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2348
Mailing Address - Country:US
Mailing Address - Phone:713-798-5808
Mailing Address - Fax:713-798-0223
Practice Address - Street 1:6620 MAIN ST
Practice Address - Street 2:SUITE 11D32.5
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2348
Practice Address - Country:US
Practice Address - Phone:713-798-5808
Practice Address - Fax:713-798-0223
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT198692390200000X
TXBP10048721174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program