Provider Demographics
NPI:1205913951
Name:SUPAONGPRAPA, WORAWUTE (MD)
Entity type:Individual
Prefix:
First Name:WORAWUTE
Middle Name:
Last Name:SUPAONGPRAPA
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 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:202 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1507
Practice Address - Country:US
Practice Address - Phone:608-417-5950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37843207RC0200X, 207RP1001X
MIEMC0001791207RC0200X, 207RP1001X
NC2022-00633207RP1001X
MT114809207RP1001X
KS04-45553207RP1001X
WI1674-320207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY610475281OtherCHA
KY610475281OtherHUMANA
KY64077480Medicaid
KYH91133OtherBLUEGRASS FAMILY HEALTH
KY000000390255OtherANTHEM
KY610475281OtherUNITED HEALTH CARE
KY610475281OtherCHA
KY000000390255OtherANTHEM