Provider Demographics
NPI:1558824870
Name:HANSRIVIJIT, PANUPONG (MD, MPH)
Entity type:Individual
Prefix:MR
First Name:PANUPONG
Middle Name:
Last Name:HANSRIVIJIT
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 WESTHILL DR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4710
Mailing Address - Country:US
Mailing Address - Phone:715-847-2371
Mailing Address - Fax:
Practice Address - Street 1:3300 WESTHILL DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4710
Practice Address - Country:US
Practice Address - Phone:715-847-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI84734-20207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology