Provider Demographics
NPI:1669591350
Name:BOONYAPISIT, WARANGKNA (MD)
Entity type:Individual
Prefix:
First Name:WARANGKNA
Middle Name:
Last Name:BOONYAPISIT
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 1:1102 MAIDEN LANE CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1900
Mailing Address - Country:US
Mailing Address - Phone:734-972-8423
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DR
Practice Address - Street 2:TC - B1 ROOM 226
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-0999
Practice Address - Country:US
Practice Address - Phone:734-763-7392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088602207R00000X, 207RC0000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Not Answered390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program