Basic Information
Provider Information
NPI: 1659765188
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: THONGPRAYOON
FirstName: CHARAT
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 200 1ST ST SW
Address2:  
City: ROCHESTER
State: MN
PostalCode: 559050001
CountryCode: US
TelephoneNumber: 5072842511
FaxNumber: 5072842511
Practice Location
Address1: 200 1ST ST SW
Address2:  
City: ROCHESTER
State: MN
PostalCode: 55905
CountryCode: US
TelephoneNumber: 5072842511
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/23/2015
LastUpdateDate: 08/06/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/06/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RN0300X63702MNY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

No ID Information.


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