Provider Demographics
NPI:1841607256
Name:KUKIRATIRAT, JIRAYU J (DO)
Entity Type:Individual
Prefix:
First Name:JIRAYU
Middle Name:J
Last Name:KUKIRATIRAT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 LEAHY ST
Mailing Address - Street 2:SUITE 315A
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-5500
Mailing Address - Country:US
Mailing Address - Phone:231-727-5250
Mailing Address - Fax:231-727-5248
Practice Address - Street 1:1150 E SHERMAN BLVD
Practice Address - Street 2:SUITE 2400
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1871
Practice Address - Country:US
Practice Address - Phone:231-672-6336
Practice Address - Fax:231-672-6335
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021416390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program