Healthcare Provider Details

I. General information

NPI: 1609909225
Provider Name (Legal Business Name): TWATCHAI YAMCHARERN, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8244 E US HIGHWAY 36 SUITE 1230
AVON IN
46123-9613
US

IV. Provider business mailing address

8244 E US HIGHWAY 36 SUITE 1230
AVON IN
46123-9613
US

V. Phone/Fax

Practice location:
  • Phone: 317-272-1935
  • Fax: 317-272-1936
Mailing address:
  • Phone: 317-272-1935
  • Fax: 317-272-1936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number01034715
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number01034715
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number01034715
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number01034715
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number01034715
License Number StateIN

VIII. Authorized Official

Name: DR. TWATCHAI YAMCHARERN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 317-272-1935