Provider Demographics
NPI:1457334484
Name:CHOOJITAROM, THIRAVAT (MD)
Entity Type:Individual
Prefix:DR
First Name:THIRAVAT
Middle Name:
Last Name:CHOOJITAROM
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 1:311 VETERANS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4726
Mailing Address - Country:US
Mailing Address - Phone:225-665-4554
Mailing Address - Fax:225-665-6995
Practice Address - Street 1:311 VETERANS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4726
Practice Address - Country:US
Practice Address - Phone:225-665-4554
Practice Address - Fax:225-665-6995
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021846208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1681580Medicaid
LA4M181CQ60Medicare PIN
LA1681580Medicaid
LAG27780Medicare UPIN
LAG27780Medicare UPIN