MEDICARE: DR. PAIROTE JAROONWANICHKUL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	036084741	IL
2	207RH0003X	Hematology & Oncology Physician	102149	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801893979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAIROTE JAROONWANICHKUL MD

Provider Business Mailing Address
First Line	:	3655 VISTA AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-2539
Country	:	US
Telephone Number	:	314-977-4340
Fax Number	:

Provider Business Practice Location Address
First Line	:	1723 BROADWAY ST
Second Line	:	SUITE 315
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-4505
Country	:	US
Telephone Number	:	573-331-6476
Fax Number	:	573-331-6526

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	10/14/2022

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