Udom Tinsatul, MD
Individual provider Active NPI General Practice Physician · Ashley, ND
NPI 1508963950 · NPPES record last updated Mar 5, 2015
Key facts
- NPI
- 1508963950
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 3926 (ND)
- Practice address
- 612 Center Ave N
Ashley, ND 58413-7013 - Phone
- (701) 288-3431
- Fax
- (701) 288-3432
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3926 | ND | MD | Social Worker |
| 2268 | SD | MD | Surgery Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 3926 | ND | |
| Surgery Physician | 208600000X | 2268 | SD | |
| General Practice Physician | 208D00000X | 3926 | ND | Yes |
Addresses
Primary practice location
612 Center Ave N
Ashley, ND 58413-7013
Mailing address
PO Box 180
612 Center Ave N
Ashley, ND 58413-0180
Phone (701) 288-3431
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 450359987 | Other | CHAMPUS | |
| 12755 | Medicaid | ND | |
| 1714 | Other | ND | BCBS |
| 450359987000 | Other | ND | WORKERS COMP |
| 7775690 | Medicaid | SD |
Other providers in Ashley, ND
- McIntosh County Social Services
- Cori Lynn Randall
- Bethany Alyce Schlenker
- Denise Kay Schweigert
- Jeremy St. Aubin
- Melanie L Troup
- White Drug Co of Jamestown Inc
All providers in Ashley, ND · General Practice Physician in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 5, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.