Active NPI
Wiriyaporn Ridtitid
- Specialist
- Indianapolis, IN
National Provider Identifier
1801149687
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 11016940A
- Practice address
- 550 University Blvd # Uh1634
Indianapolis, IN 46202-5149 - Phone
- (317) 944-5000
- NPI assigned
- Oct 18, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 11016940A | IN | Primary |
Addresses
Primary practice location
550 University Blvd # Uh1634
Indianapolis, IN 46202-5149
Mailing address
319 N West St Apt 416
Indianapolis, IN 46202-3262
Phone (317) 748-6183
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11016940A | Other | IN | MEDICAL RESIDENCY PERMIT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11016940A | IN | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350518400000",
"number": "1801149687",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "319 N WEST ST APT 416",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462023262",
"telephone_number": "317-748-6183"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 UNIVERSITY BLVD # UH1634",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462025149",
"telephone_number": "317-944-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDTITID",
"first_name": "WIRIYAPORN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-18",
"last_updated": "2012-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "IN",
"license": "11016940A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL RESIDENCY PERMIT",
"identifier": "11016940A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.