Provider Demographics
NPI:1770895369
Name:THISAYAKORN, PAUL (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:THISAYAKORN
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 1:815 OAKCREST ST
Mailing Address - Street 2:APT. 13
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-3474
Mailing Address - Country:US
Mailing Address - Phone:773-782-7682
Mailing Address - Fax:
Practice Address - Street 1:815 OAKCREST ST
Practice Address - Street 2:APT. 13
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-3474
Practice Address - Country:US
Practice Address - Phone:773-782-7682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-8992390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program