Healthcare Provider Details

I. General information

NPI: 1114037371
Provider Name (Legal Business Name): VIROJ JUISAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E 90TH DR
MERRILLVILLE IN
46410-8102
US

IV. Provider business mailing address

9201 CALUMET AVE
MUNSTER IN
46321-2807
US

V. Phone/Fax

Practice location:
  • Phone: 219-738-2008
  • Fax: 219-738-2127
Mailing address:
  • Phone: 219-836-9024
  • Fax: 219-836-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number010-39013
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: