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Individual

WIRIYAPORN RIDTITID

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
550 UNIVERSITY BLVD # UH1634, INDIANAPOLIS, IN 46202-5149
(317) 944-5000
Mailing address
319 N WEST ST APT 416, INDIANAPOLIS, IN 46202-3262
(317) 748-6183

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
11016940A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11016940A
MEDICAL RESIDENCY PERMIT
IN
Enumeration date
10/18/2012
Last updated
10/18/2012
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