SOURASACK KIT VONGSA (NPI# 1619945524) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619945524 |
| Entity Type | Individual |
| Full Name | SOURASACK KIT VONGSA |
| Credential | MD |
| Practice Address |
2500 E Capitol Dr Ste 1200 Appleton WI 54911 |
| Mailing Address |
122 E College Ave Appleton WI 54911-5794 |
| Practice Telephone | 9208306877 |
| Practice Fax Number | 8002362236 |
| Mailing Telephone | 9209963264 |
| Mailing Fax Number | 9208305970 |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2019-08-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 47253 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 34808400 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3329 N Richmond St, Appleton, WI 54911 | 9203802727 | 9203802726 |
| Street Address |
2500 E CAPITOL DR STE 1200 |
| City | APPLETON |
| State | WI |
| Zip Code | 54911 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770857229 | Todd L Mcniesh | Physician Assistant | 2500 E Capitol Dr Ste 1200, Appleton, WI 54911-8735 | 2012-03-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912545633 | Brotherly Love, LLC | Day Training, Developmentally Disabled Services | 1513 E Frances St, Appleton, WI 54911 | 2019-12-12 |
| 1952952129 | Eagle Point Senior Living Inc | Assisted Living Facility | 995 East John Street, Appleton, WI 54911 | 2019-09-27 |
| 1619524766 | University Rx LLC | Pharmacy | 133 E College Ave, Appleton, WI 54911 | 2019-08-23 |
| 1174080063 | Shayla Russell | Counselor | Outagamie County Health and Human Services, 320 S. Walnut St., Appleton, WI 54911 | 2019-02-27 |
| 1871086645 | Megan Kilsdonk | Health Educator | 1604 N Meade St, Appleton, WI 54911 | 2018-06-07 |
| 1871085480 | Tanya Lynn Vickery | Social Worker | 410 S. Elm St., Appleton, WI 54911 | 2018-05-31 |
| 1013407501 | Teri G Metropulos | Counselor | 229 S. Morrison, Appleton, WI 54911 | 2018-05-10 |
| 1093211211 | Bonnie Anne Korytkowski | Student in an Organized Health Care Education/Training Program | 229 S. Morrison Street, Appleton, WI 54911 | 2018-04-05 |
| 1639673940 | Brett Follett | Psychologist | 401 S. Elm St., Appleton, WI 54911 | 2018-03-21 |
| 1700202892 | Brian Withrow | Counselor | 607 West 7th St., Appleton, WI 54911 | 2014-03-13 |
| Find all providers in zip 54911 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104426477 | St Gianna Molla Clinic, Inc | Family Medicine | 20 Pinewild Ct, Appleton, WI 54913-7127 | 2020-10-27 |
| 1316340946 | Gerald Mich | Family Medicine | 9636 Lois Ln, Appleton, WI 54914-9024 | 2014-09-26 |
| 1730347196 | Joanne Marie Budi | Family Medicine | W2497 Brookhaven Ct, Appleton, WI 54915-8194 | 2008-06-01 |
| 1235346586 | Scott Michael Gyorog | Family Medicine | 3916 N Intertech Court, Appleton, WI 54913-6957 | 2007-05-17 |
| 1538229729 | Nicole A Brady | Family Medicine | N9642 County Trunk N, Appleton, WI 54915 | 2006-12-11 |
| 1205871779 | Leonard Leveille | Family Medicine | 4480 W Spencer St, Appleton, WI 54914-9106 | 2006-06-18 |
| 1811965494 | Michael T Werner | Family Medicine | 59 Park Pl Ste 100, Appleton, WI 54914-8230 | 2006-03-09 |
| 1669452280 | Julianne Falleroni | Family Medicine | W3124 Van Roy Road, Appleton, WI 54915 | 2006-01-19 |
| 1821084450 | Robert M Makeever | Family Medicine | 201 E Timberline Dr, Appleton, WI 54913-7121 | 2005-09-20 |
| 1316932379 | Jonathan E Hagen | Family Medicine | 55 Meadow Row Ct, Appleton, WI 54913-9511 | 2005-09-15 |
| Find all providers in APPLETON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.