Provider Demographics
NPI:1588621254
Name:CHAUHAN, RAVI DINESH (MD)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:DINESH
Last Name:CHAUHAN
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 1:1325 WOLF PARK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1742
Mailing Address - Country:US
Mailing Address - Phone:901-252-3411
Mailing Address - Fax:901-384-6422
Practice Address - Street 1:1325 WOLF PARK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1742
Practice Address - Country:US
Practice Address - Phone:901-252-3400
Practice Address - Fax:901-682-0047
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37352208800000X
MS18832208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
35171OtherTLC TENNCARE
TN4101363OtherBLUE CROSS
05090011800OtherQUAL CHOICE
3330782OtherTENNCARE (ALL OTHER PLANS
TN3330782Medicaid
13427577OtherPHCS
4101363OtherTENNCARE SELECT
211159OtherSOUTHERN HEALTH SERVICES
5656234OtherFIRST HEALTH
7876654OtherAETNA
9640627OtherCIGNA
13427577OtherPHCS
TN3330782Medicare ID - Type Unspecified
211159OtherSOUTHERN HEALTH SERVICES