Provider Demographics
NPI:1790814770
Name:UDAY CHAUHAN MD PA
Entity Type:Organization
Organization Name:UDAY CHAUHAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:UDAY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-456-5159
Mailing Address - Street 1:2720 REBECCA LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8351
Mailing Address - Country:US
Mailing Address - Phone:386-456-5159
Mailing Address - Fax:386-456-0139
Practice Address - Street 1:2720 REBECCA LN
Practice Address - Street 2:SUITE 101
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8351
Practice Address - Country:US
Practice Address - Phone:386-456-5159
Practice Address - Fax:386-456-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73576207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty