Provider Demographics
NPI:1407083744
Name:CHAVES, IAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:J
Last Name:CHAVES
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 1:9825 KENWOOD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6252
Mailing Address - Country:US
Mailing Address - Phone:513-872-4518
Mailing Address - Fax:513-527-0416
Practice Address - Street 1:9825 KENWOOD RD STE 105
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-6252
Practice Address - Country:US
Practice Address - Phone:513-872-4518
Practice Address - Fax:513-527-0416
Is Sole Proprietor?:No
Enumeration Date:2009-06-13
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361379622085R0202X
NC2014-006902085R0202X
OH351331452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0279753Medicaid
KY7100525240Medicaid
IL036137962Medicaid