MEDICARE: DR. WARIT JITHPRATUCK 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	207R00000X	Internal Medicine Physician	101249541	VA
2	207R00000X	Internal Medicine Physician	MD49723	TN
3	390200000X	Student in an Organized Health Care Education/Training Program
4	207K00000X	Allergy & Immunology Physician	ME128473	FL

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	:	1942462924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WARIT JITHPRATUCK MD

Provider Business Mailing Address
First Line	:	661 E ALTAMONTE DR STE 315
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-5103
Country	:	US
Telephone Number	:	407-339-3002
Fax Number	:	407-260-5039

Provider Business Practice Location Address
First Line	:	661 E ALTAMONTE DR STE 315
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-5103
Country	:	US
Telephone Number	:	407-339-3002
Fax Number	:	407-260-5039

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

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	10/11/2019

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Directions to “ DR. WARIT JITHPRATUCK MD” Practice Location

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