Most Relevant Information
Provider Data
| NPI Number: | 1003470568 |
| Provider Name: | NUTTAVUT SUMRANSUB M.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/30/2019 |
| Last Updated: | 06/17/2024 |
Provider Practice Location
420 DELAWARE STREET SE, MMC 284
MINNEAPOLIS
MN
55455
Practice Location Phone/Fax
| Phone: | 6126265454 |
| Fax: |
Provider Mailing Location
420 DELAWARE STREET SE, MMC 284
MINNEAPOLIS
MN
55455
Provider Mailing Phone/Fax
| Phone: | 6126265454 |
| Fax: |