Provider Demographics
NPI:1942462924
Name:JITHPRATUCK, WARIT (MD)
Entity Type:Individual
Prefix:DR
First Name:WARIT
Middle Name:
Last Name:JITHPRATUCK
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 1:661 E ALTAMONTE DR STE 315
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5103
Mailing Address - Country:US
Mailing Address - Phone:407-339-3002
Mailing Address - Fax:407-260-5039
Practice Address - Street 1:661 E ALTAMONTE DR STE 315
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5103
Practice Address - Country:US
Practice Address - Phone:407-339-3002
Practice Address - Fax:407-260-5039
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101249541207R00000X
TNMD49723207R00000X
390200000X
FLME128473207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program