Provider Demographics
NPI:1689627846
Name:CHAVDA, SURESH N (MD)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:N
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 1:6015 JERICHO CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-2139
Mailing Address - Country:US
Mailing Address - Phone:972-733-4186
Mailing Address - Fax:
Practice Address - Street 1:1625 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5005
Practice Address - Country:US
Practice Address - Phone:915-747-4000
Practice Address - Fax:214-712-2444
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2537207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D16230Medicare UPIN