Individual
TANAWAT JIRAKULAPORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
516 DELAWARE ST SE, 14-142 PWB, MINNEAPOLIS, MN 55455-0356
(612) 624-0123
Mailing address
2285 STEWART AVE APT 1411, SAINT PAUL, MN 55116-3155
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MDR-4590
HI
Other
Enumeration date
06/13/2007
Last updated
07/08/2007
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