PERMPORN VANASUPA

PORT HURON, MI
NPI1679507511
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: MI  40301032135)
Enumeration Date2006-07-10
Last Update Date2007-07-08
Business Address
-- PERMPORN VANASUPA MD
1225 10TH ST HURON FAMILY PRACTICE CENTER
PORT HURON, MI 48060
Phone number: 810-987-6200
Mailing Address
-- PERMPORN VANASUPA MD
5041 LONGVIEW DR
TROY, MI 48098
Phone number: 810-987-6200