Permporn Vanasupa, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

40301032135 Issued in MI

Practice address

1225 10TH St
Huron Family Practice Center
Port Huron, MI 48060

Phone

(810) 987-6200

Fax

(810) 987-8717

NPI assigned

Jul 10, 2006

Sex

Male

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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Huron Family Practice Center PC

  • Primary Care Clinic/Center
  • Port Huron, MI
  • NPI 1326070145

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679507511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5041 LONGVIEW DR",
            "city": "TROY",
            "state": "MI",
            "postal_code": "48098",
            "telephone_number": "810-987-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 10TH ST",
            "address_2": "HURON FAMILY PRACTICE CENTER",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "48060",
            "telephone_number": "810-987-6200",
            "fax_number": "810-987-8717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANASUPA",
        "first_name": "PERMPORN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "40301032135",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US FEDERAL",
            "identifier": "AV9479088",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN LICENSE NUMBER",
            "identifier": "4301032135",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3184814",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Neha Uppal, MD
• Cortney L Uresti
• Urology Assoc of Port Huron, P.C.
• Arunas S Vaitiekaitis, DDS
• Krishna D Valjee, MD
• Lawrence K Vanbelle, RPH
• Rosemary Jean Vanbuskirk
• Susan J Vandellen, D.O.
• Kacey Ann Vanderpool, LLBSW
• Taylor Ann Vandusen

• Family Medicine Physician in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.