Provider Demographics
NPI:1992955397
Name:VISAVACHAIPAN, NIPAPAT (MD)
Entity type:Individual
Prefix:
First Name:NIPAPAT
Middle Name:
Last Name:VISAVACHAIPAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 S CALUMET AVE
Mailing Address - Street 2:APT# 809
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4627
Mailing Address - Country:US
Mailing Address - Phone:312-799-1808
Mailing Address - Fax:
Practice Address - Street 1:1841 S CALUMET AVE
Practice Address - Street 2:APT# 809
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4627
Practice Address - Country:US
Practice Address - Phone:312-799-1808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125053293208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics