Active NPI
Mingquan Tongbhakdee Suksanong, M.D.
- Infectious Disease Physician
- St Petersburg, FL
National Provider Identifier
1790746840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Infectious Disease Physician
- License
- ME0031666
- Practice address
- 1752 MLK Jr St N
St Petersburg, FL 33704-4206 - Phone
- (727) 823-7224
- Fax
- (727) 489-9486
- NPI assigned
- Mar 29, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Infectious Disease Physician | 207RI0200X | ME0031666 | FL | Primary |
Addresses
Primary practice location
1752 MLK Jr St N
St Petersburg, FL 33704-4206
Mailing address
PO Box 1945
Palm Harbor, FL 34682-1945
Phone (727) 771-1300
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 52999 | Other | FL | BCBS |
| P00883306 | Other | FL | RAILROAD MEDICARE |
| 160184600 | Other | FL | WORK COMP |
| 059830500 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME0031666 | FL | MD | Infectious Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Infectious Disease Consultants of West Florida LLC | Infectious Disease | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Infectious Disease Physician
- Tampa, FL
- NPI 1609304849
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335830400000",
"number": "1790746840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1945",
"city": "PALM HARBOR",
"state": "FL",
"postal_code": "346821945",
"telephone_number": "727-771-1300",
"fax_number": "727-781-2300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1752 MLK JR ST N",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337044206",
"telephone_number": "727-823-7224",
"fax_number": "727-489-9486"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUKSANONG",
"first_name": "MINGQUAN",
"middle_name": "TONGBHAKDEE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-29",
"last_updated": "2012-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "207RI0200X",
"taxonomy_group": "",
"desc": "Internal Medicine, Infectious Disease",
"state": "FL",
"license": "ME0031666",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "52999",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00883306",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WORK COMP",
"identifier": "160184600",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "059830500",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.