Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 010-39013 | IN |
NPI | 1114037371 |
---|---|
Provider Name | Viroj Juisai |
First Address | Munster, IN 46321-2807 |
Second Address | Merrillville, IN 46410-8102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 12/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100383490 | (05) | IN |
D27765 | (02) |