Individual
THANITA THONGTAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
550 S LANDMARK AVE, BLOOMINGTON, IN 47403-3239
(812) 355-6900
Mailing address
5520 LEONARDO DA VINCI STE 100, EDINBURG, TX 78539-1422
(956) 362-3636
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01095800A
IN
207RG0100X
Gastroenterology Physician
Primary
01095800A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
TX
Other
Enumeration date
05/09/2019
Last updated
12/15/2025
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