Preecha Supanwanid MD PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

4301037471 Issued in MI

Legal business name

PREECHA SUPANWANID MD PC

Practice address

921 Abbot Rd
East Lansing, MI 48823-3170

Phone

(517) 336-6950

Fax

(517) 336-6952

NPI assigned

Nov 1, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Preecha Supanwanid, MDNPI 1669661450

Title

Business Owner

Phone

(517) 336-6950

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Preecha Supanwanid, M.D.

  • Plastic Surgery Physician
  • East Lansing, MI
  • NPI 1669661450
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193875200000",
    "number": "1326227786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 ABBOT RD",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488233170",
            "telephone_number": "517-336-6950",
            "fax_number": "517-336-6952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 ABBOT RD",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488233170",
            "telephone_number": "517-336-6950",
            "fax_number": "517-336-6952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREECHA SUPANWANID MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-01",
        "last_updated": "2007-11-01",
        "status": "A",
        "authorized_official_last_name": "SUPANWANID",
        "authorized_official_first_name": "PREECHA",
        "authorized_official_title_or_position": "BUSINESS OWNER",
        "authorized_official_telephone_number": "517-336-6950",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MI",
            "license": "4301037471",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0338503",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1391276",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelli Lee Potter, H.A.D.
• John W. Powell, PHD, ATC
• Samantha Poyer
• Praising Jesus Christ for Life LLC (More Space Mental Health)
• Precision Counseling
• Preecha Supanwanid, MD PC
• Premier Counseling and Wellness Institute
• Prestige Mindsets Counseling
• Kimberly Preston
• Mick Allen Preston Jr., RN

• Specialist in East Lansing, MI
• Providers in East Lansing, MI by specialty
• Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.