Provider Demographics
NPI:1801057724
Name:LAOWANSIRI, PANTHIPA (MD)
Entity type:Individual
Prefix:
First Name:PANTHIPA
Middle Name:
Last Name:LAOWANSIRI
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 1:2020 OAKLEY SEAVER DR
Mailing Address - Street 2:STE 1
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1902
Mailing Address - Country:US
Mailing Address - Phone:352-404-7718
Mailing Address - Fax:352-404-7723
Practice Address - Street 1:1576 BELLA CRUZ DR
Practice Address - Street 2:SUITE 336
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-8969
Practice Address - Country:US
Practice Address - Phone:224-610-9552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125052304207R00000X
FLME111833207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine