Nirandon Wongsurawat, MD

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

MD34919 Issued in MO

Practice address

1015 Bowles Ave
Fenton, MO 63026-1530

Phone

(636) 566-8155

Fax

(314) 966-0323

NPI assigned

Aug 16, 2006

Last updated

Jun 29, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277769600000",
    "number": "1376656116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 BOWLES AVE",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630261530",
            "telephone_number": "636-566-8155",
            "fax_number": "314-966-0323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 BOWLES AVE",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630261530",
            "telephone_number": "636-566-8155",
            "fax_number": "314-966-0323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONGSURAWAT",
        "first_name": "NIRANDON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2010-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MO",
            "license": "MD34919",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205205701",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tracy Lynn Winkelmann, FNP
• Rebekah A Witte, PT, DPT
• Richard Felix Wittock III, D.P.M.
• Carrie Wolf, PT
• Laura K Wolters, PT, DPT
• Steven Michael Workman, D.M.D.
• Wuca-Fenton Pediatrics, LLC
• Michelle L Yepez, RPH
• Joseph Theodore Young, M.D.
• Sheikh M Zahid, M.D.

• Endocrinology, Diabetes & Metabolism Physician in Fenton, MO
• Providers in Fenton, MO by specialty
• Endocrinology, Diabetes & Metabolism Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.