Healthcare Provider Details

I. General information

NPI: 1679420103
Provider Name (Legal Business Name): SIRAPA VICHAIKUL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 1ST ST
FLINT MI
48502-1902
US

IV. Provider business mailing address

2119 PINEBROOK MEADOW CT
HOWELL MI
48843-8489
US

V. Phone/Fax

Practice location:
  • Phone: 810-600-5600
  • Fax:
Mailing address:
  • Phone: 517-518-0228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: