Provider Demographics
NPI:1457716961
Name:NUTTANUN SURAMAETHAKUL MD LLC
Entity Type:Organization
Organization Name:NUTTANUN SURAMAETHAKUL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NUTTANUN
Authorized Official - Middle Name:
Authorized Official - Last Name:SURAMAETHAKUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-268-6830
Mailing Address - Street 1:1151 E 3900 S
Mailing Address - Street 2:SUITE B299
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1216
Mailing Address - Country:US
Mailing Address - Phone:801-268-6830
Mailing Address - Fax:801-262-3584
Practice Address - Street 1:1151 E 3900 S
Practice Address - Street 2:SUITE B299
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1216
Practice Address - Country:US
Practice Address - Phone:801-268-6830
Practice Address - Fax:801-262-3584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9492315-1205207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty