Provider Demographics
NPI:1336198209
Name:CHAHLAVI, ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:CHAHLAVI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4205 BELFORT RD
Mailing Address - Street 2:JOE ADAMS BUILDING SUITE 1100
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1471
Mailing Address - Country:US
Mailing Address - Phone:904-296-3103
Mailing Address - Fax:904-296-3106
Practice Address - Street 1:4205 BELFORT RD
Practice Address - Street 2:JOE ADAMS BUILDING SUITE 1100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5876
Practice Address - Country:US
Practice Address - Phone:904-296-3103
Practice Address - Fax:904-296-3106
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2014-05-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME95578207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME95578OtherMEDICAL LICENSE