Provider Demographics
NPI:1356430623
Name:CHAUHAN, KETUL (MD)
Entity type:Individual
Prefix:
First Name:KETUL
Middle Name:
Last Name:CHAUHAN
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 2709
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33539-2709
Mailing Address - Country:US
Mailing Address - Phone:813-788-1400
Mailing Address - Fax:813-788-7691
Practice Address - Street 1:38035 MEDICAL CENTER AVENUE
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540-1384
Practice Address - Country:US
Practice Address - Phone:813-788-1400
Practice Address - Fax:813-788-7691
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88769207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2782596-00Medicaid
FL257259600Medicaid
FLME88769OtherLICENSE
FLME88769OtherLICENSE
FL2782596-00Medicaid