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Individual
UDOM TINSATUL
Active
Individual
UDOM TINSATUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2268
SD
208600000X
Surgery Physician
3926
ND
208D00000X
General Practice Physician
Primary
3926
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12755
—
ND
01
—
1714
BCBS
ND
01
—
450359987
CHAMPUS
—
01
—
450359987000
WORKERS COMP
ND
05
—
7775690
—
SD
Enumeration date
09/20/2006
Last updated
03/05/2015
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