Healthcare Provider Details

I. General information

NPI: 1033248869
Provider Name (Legal Business Name): PRASIT SRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PRASIT SRI-UTHAYOPAS M.D.

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9034 COLUMBIA AVE
MUNSTER IN
46321-2905
US

IV. Provider business mailing address

9034 COLUMBIA AVE
MUNSTER IN
46321-2905
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-0296
  • Fax: 219-836-0570
Mailing address:
  • Phone: 219-836-0296
  • Fax: 219-836-0570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01025002A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: