Provider Demographics
NPI:1851742514
Name:VORAKUNTHADA, YUTTIWAT (MD)
Entity Type:Individual
Prefix:MR
First Name:YUTTIWAT
Middle Name:
Last Name:VORAKUNTHADA
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 1:223 INDIANA AVE
Mailing Address - Street 2:APT 5109
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79415-3370
Mailing Address - Country:US
Mailing Address - Phone:312-576-1793
Mailing Address - Fax:
Practice Address - Street 1:TEXAS TECH UNIVERSITY HEALTH SCIENCES CTR
Practice Address - Street 2:3601 4TH ST
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0001
Practice Address - Country:US
Practice Address - Phone:806-743-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10056148207R00000X
NH23020207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease