Individual
PANUPONG LISAWAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 OSBORNE ST, SUITE 210, DANBURY, CT 06810-6000
(203) 739-7104
Mailing address
111 OSBORNE ST, SUITE 210, DANBURY, CT 06810-6000
(203) 739-7104
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
051569
CT
207RN0300X
Nephrology Physician
Primary
051569
CT
208M00000X
Hospitalist Physician
051569
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/07/2008
Last updated
12/04/2013
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