Healthcare Provider Details

I. General information

NPI: 1346656063
Provider Name (Legal Business Name): WATCHARA LOHAWIJARN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE SPARROW HOSPITAL
LANSING MI
48909
US

IV. Provider business mailing address

1200 E MICHIGAN AVE
LANSING MI
48912
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-2767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301105617
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: