Individual
RONACHAI BANCHONGMANIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5341 MITSCHER AVE, LOUISVILLE, KY 40214-2633
(502) 375-4900
Mailing address
DEPT 8241, CAROL STREAM, IL 60122-8241
(866) 286-9915
(502) 471-2051
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
17611
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64176118
—
KY
Enumeration date
01/10/2007
Last updated
07/08/2007
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