Provider Demographics
NPI:1508802976
Name:CHAUHAN, DIVYA (MD)
Entity Type:Individual
Prefix:
First Name:DIVYA
Middle Name:
Last Name:CHAUHAN
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 1:11550 OLIVE BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7111
Mailing Address - Country:US
Mailing Address - Phone:314-523-2590
Mailing Address - Fax:314-590-5943
Practice Address - Street 1:11550 OLIVE BLVD
Practice Address - Street 2:STE 120
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7111
Practice Address - Country:US
Practice Address - Phone:314-523-2590
Practice Address - Fax:314-590-5943
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2004000453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA4396001Medicare PIN
MOI14499Medicare UPIN