Individual
SOMCHAI LAOWATTANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-5200
(414) 259-0469
Mailing address
12632 S HARLEM AVE, PALOS HEIGHTS, IL 60463-1428
(708) 587-0000
(708) 623-7628
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
036154960
IL
2084N0400X
Neurology Physician
Primary
52265-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245315365
—
WI
Enumeration date
10/26/2006
Last updated
10/11/2023
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