| Dr Kobkit Putrakul, MD | |
|
210 Marie Langdon Dr, Manchester, KY 40962 | |
| (606) 598-5104 | |
| (606) 983-7252 |
| Full Name | Dr Kobkit Putrakul |
|---|---|
| Gender | Male |
| Speciality | Emergency Medicine |
| Location | 210 Marie Langdon Dr, Manchester, Kentucky |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699951558 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | TP656 (Kentucky) | Secondary |
| 207P00000X | Emergency Medicine | 41570 (Kentucky) | Primary |
| Entity Name | Memorial Hospital, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1831150119 PECOS PAC ID: 4486616141 Enrollment ID: O20041103001183 |
| Entity Name | Southeastern Emergency Physicians Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1356379382 PECOS PAC ID: 2466364997 Enrollment ID: O20050302000285 |
| Entity Name | Concord Medical Group Of Kentucky Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1346746385 PECOS PAC ID: 9133483894 Enrollment ID: O20180503002233 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Kobkit Putrakul, MD 600 Greenway Dr, London, KY 40741-1629 Ph: (606) 401-5490 | Dr Kobkit Putrakul, MD 210 Marie Langdon Dr, Manchester, KY 40962 Ph: (606) 598-5104 |
Ashraf Azeb, MD Emergency Medicine Medicare: Medicare Enrolled Practice Location: 210 Marie Langdon Dr, Manchester, KY 40962 Phone: 606-598-5104 Fax: 865-291-3228 |