NPIMap

Individual provider Active NPI

Siwadon Pitukweerakul, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • Saint Paul, MN
National Provider Identifier
1487063087
Registry record updated May 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
71044 Issued in MN
Practice address
401 Phalen Blvd
Saint Paul, MN 55130-5302
Phone
(651) 254-7870
Fax
(651) 254-7876
NPI assigned
Aug 7, 2014
Last updated
May 10, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125064744 IL
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 70060 WI
Internal Medicine Physician 207R00000X 94-09342 KS
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 71044 MN Primary

Addresses

Primary practice location

401 Phalen Blvd
Saint Paul, MN 55130-5302

Mailing address

8170 33Rd Ave S
Ms 21110Q
Bloomington, MN 55425-4516

Other practice location 1

1000 N Oak Ave
Marshfield, WI 54449-5703
Phone (715) 387-5484

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190829003667 WI Practitioner - EndocrinologyPractitioner - Internal Medicine 2860764784 Reassigns benefits to 2 organizations
I20220727003142 MN Practitioner - Endocrinology 2860764784 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

11475 Robinson Dr NW
Coon Rapids, MN 55433-3746
Phone (763) 754-0041

14701 Victor Hugo Blvd N
Hugo, MN 55038-4561
Phone (651) 767-1900

15350 English Ave
Apple Valley, MN 55124-6252
Phone (952) 431-8500

1654 Diffley Rd
Suite 100
Eagan, MN 55122-2237
Phone (651) 641-3900

205 Wabasha Ave S
Saint Paul, MN 55107-1805

233 Radio Dr
Woodbury, MN 55125-5805
Phone (952) 967-7616

2500 Como Ave
Saint Paul, MN 55108-1460
Phone (651) 641-0020

2621 Greenhaven Rd
Anoka, MN 55303-1776
Phone (952) 853-8800

2635 University Ave W
Suite 160
Saint Paul, MN 55114-1271
Phone (651) 254-3500

2831 Snelling N Ave
Roseville, MN 55113-2460
Phone (651) 636-4525

295 Phalen Blvd
Saint Paul, MN 55130-2400
Phone (651) 495-6200

401 Phalen Blvd
Saint Paul, MN 55130-5302
Phone (651) 254-7400

435 Phalen Blvd
Saint Paul, MN 55130-5302
Phone (651) 291-2848

576 Apollo Dr
Lino Lakes, MN 55014-3004
Phone (651) 784-1611

640 Jackson St
Saint Paul, MN 55101-2502
Phone (651) 221-3456

6845 Lee Ave N
Brooklyn Center, MN 55429-1717
Phone (763) 503-4400

8325 Seasons Pkwy
Woodbury, MN 55125-4402
Phone (651) 702-5868

8450 Seasons Pkwy
Woodbury, MN 55125-4402
Phone (651) 702-5300

8600 Nicollet Ave
Bloomington, MN 55420-2824
Phone (952) 884-1148

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
125064744ILMDInternal Medicine Physician
71044MNMDEndocrinology, Diabetes & Metabolism Physician
70060WIMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MCHS Hospitals Inc Internal Medicine CurrentSince Aug 12, 2019 Accepting new patients
MCHS Hospitals Inc CurrentSince Aug 12, 2019 Accepting new patients
Group Health, Inc. CurrentSince Aug 22, 2022 Accepting new patients
Group Health, Inc. CurrentSince Aug 22, 2022 Accepting new patients
Marshfield Clinic Inc CurrentSince Aug 12, 2019 Accepting new patients

Locations

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

401 Phalen Blvd
Saint Paul, MN 55130
Phone (651) 254-7870

1000 Starr Ave
Eau Claire, WI 54703
Phone (715) 858-4850

3501 Golf Rd
Eau Claire, WI 54701
Phone (715) 858-4200

1000 N Oak Ave
Marshfield, WI 54449
Phone (715) 387-5111

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 19

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1407369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715299200000",
    "number": "1487063087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S",
            "address_2": "MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 PHALEN BLVD",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551305302",
            "telephone_number": "651-254-7870",
            "fax_number": "651-254-7876"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 N Oak Ave",
            "address_purpose": "LOCATION",
            "city": "Marshfield",
            "state": "WI",
            "postal_code": "544495703",
            "country_code": "US",
            "telephone_number": "715-387-5484",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PITUKWEERAKUL",
        "first_name": "SIWADON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-07",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125064744",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "WI",
            "license": "70060",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "94-09342",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MN",
            "license": "71044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.