MEDICARE: DR. THIRAVAT CHOOJITAROM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	021846	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457334484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THIRAVAT CHOOJITAROM M.D.

Provider Business Mailing Address
First Line	:	311 VETERANS BLVD
Second Line	:	SUITE B
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4726
Country	:	US
Telephone Number	:	225-665-4554
Fax Number	:	225-665-6995

Provider Business Practice Location Address
First Line	:	311 VETERANS BLVD
Second Line	:	SUITE B
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4726
Country	:	US
Telephone Number	:	225-665-4554
Fax Number	:	225-665-6995

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	02/10/2021

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