Provider Demographics
NPI:1124218128
Name:CHAVDA, KEYUR ANILKUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:KEYUR
Middle Name:ANILKUMAR
Last Name:CHAVDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 PARSONS PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6066
Mailing Address - Country:US
Mailing Address - Phone:813-684-5255
Mailing Address - Fax:
Practice Address - Street 1:116 PARSONS PARK DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6066
Practice Address - Country:US
Practice Address - Phone:813-684-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT186813390200000X
FLME109259208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003631400Medicaid
FL003631400Medicaid