Provider Demographics
NPI:1154651073
Name:PRASERTWITAYAKIJ, NARAWUDT (MD)
Entity Type:Individual
Prefix:DR
First Name:NARAWUDT
Middle Name:
Last Name:PRASERTWITAYAKIJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E MICHIGAN AVE
Mailing Address - Street 2:EP FELLOWS OFFICE: HEART & VASCULAR CENTER
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1800
Mailing Address - Country:US
Mailing Address - Phone:517-364-3414
Mailing Address - Fax:517-364-2867
Practice Address - Street 1:1200 E MICHIGAN AVE
Practice Address - Street 2:EP FELLOWS OFFICE: HEART & VASCULAR CENTER
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1800
Practice Address - Country:US
Practice Address - Phone:517-364-3414
Practice Address - Fax:517-364-2867
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301094951174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist