Provider Demographics
NPI:1467688937
Name:CHOTCHAI SRISURO, M.D., INC.
Entity Type:Organization
Organization Name:CHOTCHAI SRISURO, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHOTCHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:SRISURO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-518-3665
Mailing Address - Street 1:1011 BOWLES AVE
Mailing Address - Street 2:SUITE G10
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2387
Mailing Address - Country:US
Mailing Address - Phone:636-496-5450
Mailing Address - Fax:636-496-4963
Practice Address - Street 1:1011 BOWLES AVE
Practice Address - Street 2:SUITE G10
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2387
Practice Address - Country:US
Practice Address - Phone:636-496-5450
Practice Address - Fax:636-496-4963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO33186207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty