Provider Demographics
NPI:1699860783
Name:WANGKEO, DUSIT (MD)
Entity Type:Individual
Prefix:
First Name:DUSIT
Middle Name:
Last Name:WANGKEO
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:OUR LADY OF MERCY MEDICAL CENTER
Mailing Address - Street 2:600 E. 233RD STREET, DEPT. OF ANESTHESIOLOGY
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466
Mailing Address - Country:US
Mailing Address - Phone:718-290-9510
Mailing Address - Fax:
Practice Address - Street 1:OUR LADY OF MERCY MEDICAL CENTER
Practice Address - Street 2:600 E. 233RD STREET, DEPT. OF ANESTHESIOLOGY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466
Practice Address - Country:US
Practice Address - Phone:718-290-9510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133216207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00269952Medicaid
NY333662Medicare ID - Type Unspecified
NY00269952Medicaid