Provider Demographics
NPI:1780953448
Name:CHIRUND LAVA, M.D. PA
Entity type:Organization
Organization Name:CHIRUND LAVA, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIRUND
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-421-6210
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 A
Practice Address - Street 2:STE 2
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-4948
Practice Address - Country:US
Practice Address - Phone:620-421-6210
Practice Address - Fax:620-421-9394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0416569208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty