Provider Demographics
NPI:1205918406
Name:VITURAWONG, VICHIT (MD,FCCP)
Entity type:Individual
Prefix:DR
First Name:VICHIT
Middle Name:
Last Name:VITURAWONG
Suffix:
Gender:M
Credentials:MD,FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17273 STATE ROUTE 104
Mailing Address - Street 2:QUARTER 13NORTH
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8608
Mailing Address - Country:US
Mailing Address - Phone:740-773-1141
Mailing Address - Fax:740-772-7074
Practice Address - Street 1:17273 STATE ROUTE 104
Practice Address - Street 2:QUARTER 13NORTH
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8608
Practice Address - Country:US
Practice Address - Phone:740-773-1141
Practice Address - Fax:740-772-7074
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21635174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist