Chutcharn Kongphanich, M.D.

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

License

4301088636 Issued in MI

Practice address

1044 Island Drive CT Apt 104
Ann Arbor, MI 48105-2075

Phone

(734) 883-3181

NPI assigned

Mar 30, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1851411227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 ISLAND DRIVE CT APT 104",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481052075",
            "telephone_number": "734-883-3181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 ISLAND DRIVE CT APT 104",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481052075",
            "telephone_number": "734-883-3181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONGPHANICH",
        "first_name": "CHUTCHARN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "MI",
            "license": "4301088636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Komon
• Hannah Claire Kondolf, MD, PHD
• Matthew Christopher Konerman, M.D.
• Qingchun Kong
• Shan Kong
• Anna Rebecca Konigsberg, LLMSW
• Kristine E Konopka, M.D.
• Teresa L Konopka, NP
• Laura C Konrad, OTR/L
• Kristine Marie Konz, MSW

• Vascular & Interventional Radiology Physician in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Vascular & Interventional Radiology 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.