Provider Demographics
NPI:1164465415
Name:KWI, TIMU NIRATSUWAN (MD)
Entity type:Individual
Prefix:DR
First Name:TIMU
Middle Name:NIRATSUWAN
Last Name:KWI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:PORT LAVACA
Mailing Address - State:TX
Mailing Address - Zip Code:77979-2507
Mailing Address - Country:US
Mailing Address - Phone:361-552-6721
Mailing Address - Fax:361-552-7463
Practice Address - Street 1:1200 N VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-2507
Practice Address - Country:US
Practice Address - Phone:361-552-6721
Practice Address - Fax:361-552-7463
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6546207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000H160OtherGROUP MEDICARE NUMBER
TX133513502OtherGROUP MEDICAID NUMBER
TX160771501Medicaid
TX133513502OtherGROUP MEDICAID NUMBER
TX160771501Medicaid