Provider Demographics
NPI:1356365043
Name:DHAWAN, AJAY K (MD)
Entity type:Individual
Prefix:DR
First Name:AJAY
Middle Name:K
Last Name:DHAWAN
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 1:2131 LONGLEAF DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-9555
Mailing Address - Country:US
Mailing Address - Phone:239-699-5830
Mailing Address - Fax:
Practice Address - Street 1:1108 AMBER LAKE CT
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2946
Practice Address - Country:US
Practice Address - Phone:239-699-5830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066166207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG60026Medicare UPIN