Individual
DR. KONGSAK TANPHAICHITR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11115 NEW HALLS FERRY RD, SUITE 102, FLORISSANT, MO 63033-7613
(314) 839-4339
(314) 839-0011
Mailing address
11115 NEW HALLS FERRY RD, SUITE 102, FLORISSANT, MO 63033-7613
(314) 839-4339
(314) 839-0011
Taxonomy
Speciality
Code
Description
License number
State
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
35104
MO
207RR0500X
Rheumatology Physician
Primary
35104
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200861813
—
MO
Enumeration date
12/15/2006
Last updated
08/03/2012
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