Individual
NUCHARIN SUPAKUL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
550 UNIVERSITY BLVD, ROOM 0279, INDIANAPOLIS, IN 46202-5149
(317) 944-1816
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
Primary
110155624
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201125210
—
IN
Enumeration date
07/29/2010
Last updated
03/05/2021
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