Individual
DR. MAKHAWADEE PONGRUANGPORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4950 NORTON HEALTHCARE BLVD, STE.303, LOUISVILLE, KY 40241-2845
(502) 394-6470
(502) 394-6477
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
48026
KY
208M00000X
Hospitalist Physician
2012012189
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100361830
—
KY
Enumeration date
05/27/2008
Last updated
03/21/2019
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