Uraiwan Tana Hompluem, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036067508 Issued in IL

Practice address

2 Terminal Dr
Suite 8
East Alton, IL 62024-2268

Phone

(618) 259-1419

Fax

(618) 259-1502

NPI assigned

Dec 28, 2006

Last updated

Apr 25, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Miss Uraiwan Tana Tananunkul Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461542400000",
    "number": "1477619278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 TERMINAL DR",
            "address_2": "SUITE 8",
            "city": "EAST ALTON",
            "state": "IL",
            "postal_code": "620242268",
            "telephone_number": "618-259-1419",
            "fax_number": "618-259-1502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 TERMINAL DR",
            "address_2": "SUITE 8",
            "city": "EAST ALTON",
            "state": "IL",
            "postal_code": "620242268",
            "telephone_number": "618-259-1419",
            "fax_number": "618-259-1502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOMPLUEM",
        "first_name": "URAIWAN",
        "middle_name": "TANA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-28",
        "last_updated": "2016-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036067508",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036067508",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "URAIWAN",
            "last_name": "TANANUNKUL",
            "middle_name": "TANA",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kyle Blake Hagen, D.M.D
• Deanna Sue Hampsch, LPTA CWT
• Lori B Harrison, MSW, LCSW
• Larry Dean Hawkins, PT
• Roclie D Hicks, COTA
• Euodias M Hunter, DMD
• Nakeia Jackosn
• Gretchen D Jackson, LCPC
• Nicholas Craig Johnson, DDS
• Kayclarken & Shelby LLC (SafeCare Madison Transport)

• Pediatrics Physician in East Alton, IL
• Providers in East Alton, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2016; 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.