Provider Demographics
NPI:1760049100
Name:PICHETSURNTHORN, PIE
Entity type:Individual
Prefix:
First Name:PIE
Middle Name:
Last Name:PICHETSURNTHORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 ROCKY MOUNTAIN AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9004
Mailing Address - Country:US
Mailing Address - Phone:970-237-7588
Mailing Address - Fax:970-237-7587
Practice Address - Street 1:2500 ROCKY MOUNTAIN AVE STE 330
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9004
Practice Address - Country:US
Practice Address - Phone:970-237-7588
Practice Address - Fax:970-237-7587
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2025-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-09830207R00000X
CODR.0076292207RI0200X
ORPG221003207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine