Organization
OBSTETRICAL & GYNECOLOGICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICHAI DUANGJAK M.D. (PRESIDENT)
(440) 286-6633
Entity
Organization
Contact information
Practice address
12475 HOSPITAL DR, CHARDON, OH 44024-9028
(440) 286-6633
Mailing address
12475 HOSPITAL DR, CHARDON, OH 44024-9028
(440) 286-6633
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
35034212
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0206744
—
OH
Enumeration date
07/19/2007
Last updated
07/19/2007
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