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Individual

DR. PRASERT VIJITBENJARONK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3900 ST FRANCIS WAY STE 200, LAFAYETTE, IN 47905-4940
(765) 775-2800
(765) 775-2831
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
2004009714
MO
207RC0000X
Cardiovascular Disease Physician
01090864A
IN
207RC0000X
Cardiovascular Disease Physician
2004009714
MO
207RI0011X
Interventional Cardiology Physician
Primary
01090864A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
126814
BCBS
05
155765001
AR
05
155783001
AR
01
190900
BLUE CROSS BLUE CHOICE
MO
01
190900
BCBS
05
207663907
MO
01
250766
HEALTHLINK
01
653949
HEALTHLINK
MO
01
P00244271
RAILROAD MEDICARE
Enumeration date
12/05/2005
Last updated
04/09/2024
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