Individual
CHAKORN CHANSAKUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
350 W THOMAS RD, PHOENIX, AZ 85013-4409
(602) 406-3538
Mailing address
350 W THOMAS RD, PHOENIX, AZ 85013-4409
(602) 406-3538
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
81709
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81709
TRAINING PERMIT
AZ
Enumeration date
09/09/2007
Last updated
10/18/2007
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