Basic Information
| Provider Information | |||||||||
| NPI: | 1457773210 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VASANA CHEANVECHAI MD, LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4800 NE 20TH TER | ||||||||
| Address2: | STE 109 | ||||||||
| City: | FT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333084510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543383021 | ||||||||
| FaxNumber: | 3305630604 | ||||||||
| Practice Location | |||||||||
| Address1: | 4800 NE 20TH TER | ||||||||
| Address2: | STE 109 | ||||||||
| City: | FT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333084510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543383021 | ||||||||
| FaxNumber: | 3305630604 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2014 | ||||||||
| LastUpdateDate: | 09/05/2014 | ||||||||
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| AuthorizedOfficialLastName: | DAVES | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3305630617 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | ME70243 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.