Provider Demographics
NPI:1457773210
Name:VASANA CHEANVECHAI MD, LTD
Entity Type:Organization
Organization Name:VASANA CHEANVECHAI MD, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-563-0617
Mailing Address - Street 1:4800 NE 20TH TER
Mailing Address - Street 2:STE 109
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4510
Mailing Address - Country:US
Mailing Address - Phone:954-338-3021
Mailing Address - Fax:330-563-0604
Practice Address - Street 1:4800 NE 20TH TER
Practice Address - Street 2:STE 109
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4510
Practice Address - Country:US
Practice Address - Phone:954-338-3021
Practice Address - Fax:330-563-0604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME702432086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty