Individual
PHORNPHAT RASAMIMARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., MPH
Contact information
Practice address
901 MACARTHUR BLVD, NEONATOLOGY DEPARTMENT, MUNSTER, IN 46321-2901
(219) 836-2022
Mailing address
9201 CALUMET AVE, MUNSTER, IN 46321-2807
(219) 836-2022
(219) 836-0034
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
036-098723
IL
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
01060038A
IN
2080N0001X
Neonatal-Perinatal Medicine Physician
036-098723
IL
208M00000X
Hospitalist Physician
01060038A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000964820
ANTHEM PROVIDER NUMBER
IN
05
—
200510260
—
IN
01
—
M471400271
MEDICARE
IN
Enumeration date
12/27/2005
Last updated
04/28/2021
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