Individual
NUTTANUN SURAMAETHAKUL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1151 E 3900 S STE B275, SALT LAKE CITY, UT 84124-1259
(801) 268-6830
(801) 262-3584
Mailing address
1151 E 3900 S STE B275, SALT LAKE CITY, UT 84124-1259
(801) 268-6830
(801) 262-3584
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
57.014260
OH
207RI0200X
Infectious Disease Physician
Primary
9492315-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689816605
—
UT
Enumeration date
04/06/2009
Last updated
07/21/2022
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