Provider Demographics
NPI:1861499717
Name:LAVA, CHIRUND (MD)
Entity Type:Individual
Prefix:
First Name:CHIRUND
Middle Name:
Last Name:LAVA
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:PO BOX 290
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-0290
Mailing Address - Country:US
Mailing Address - Phone:620-421-6210
Mailing Address - Fax:620-421-9394
Practice Address - Street 1:1902 S HWY 59 BLDG SUITE 2
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357
Practice Address - Country:US
Practice Address - Phone:620-421-6210
Practice Address - Fax:620-421-9394
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-16569208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1364OtherBCBS
KS100083500AMedicaid
B68521Medicare UPIN
KS1364Medicare ID - Type Unspecified