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General NPI Number Information
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NPI Number | 1467688937
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Entity Type | Organization
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Legal Business Name | CHOTCHAI SRISURO, M.D., INC.
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Dates
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Enumeration Date | 06/10/2009
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Last Update Date | 06/10/2009
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Provider Practice Location Address
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Address Line | 1011 BOWLES AVE SUITE G10
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City | FENTON
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State | MO
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Zip | 63026-2387
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Country | US
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Telephone | 636-496-5450
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Fax | 636-496-4963
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Provider Business Mailing Address
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Address Line | 1011 BOWLES AVE SUITE G10
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City | FENTON
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State | MO
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Zip | 63026-2387
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Country | US
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Telephone | 636-496-5450
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Fax | 636-496-4963
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHOTCHAI SRISURO
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Credential | M.D.
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Telephone | 314-518-3665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 33186
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License Number State | MO
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