Healthcare Provider Details

I. General information

NPI: 1841607256
Provider Name (Legal Business Name): JIRAYU J KUKIRATIRAT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 E SHERMAN BLVD SUITE 2400
MUSKEGON MI
49444-1871
US

IV. Provider business mailing address

1675 LEAHY ST SUITE 315A
MUSKEGON MI
49442-5500
US

V. Phone/Fax

Practice location:
  • Phone: 231-672-6336
  • Fax: 231-672-6335
Mailing address:
  • Phone: 231-727-5250
  • Fax: 231-727-5248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number5101021416
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: