Healthcare Provider Details

I. General information

NPI: 1003872615
Provider Name (Legal Business Name): VORACHART AUETHAVEKIAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 04/15/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ DIV IM HEMATOLOGY
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-7216
  • Fax: 314-362-8813
Mailing address:
  • Phone: 314-362-7216
  • Fax: 314-362-8813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number101123
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number101123
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: