Provider Demographics
NPI:1215599261
Name:DEJHANSATHIT, SIROJ (MD)
Entity Type:Individual
Prefix:DR
First Name:SIROJ
Middle Name:
Last Name:DEJHANSATHIT
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 1:34 BROADWAY VILLAGE DR APT E
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8656
Mailing Address - Country:US
Mailing Address - Phone:806-224-3973
Mailing Address - Fax:
Practice Address - Street 1:3315 BERRYWOOD DR STE 201
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6571
Practice Address - Country:US
Practice Address - Phone:806-224-3973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-30
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2022021291207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program