Provider Demographics
NPI:1912228131
Name:CHAVDA, KIRAN (DO)
Entity Type:Individual
Prefix:
First Name:KIRAN
Middle Name:
Last Name:CHAVDA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4987 KERNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3614
Mailing Address - Country:US
Mailing Address - Phone:727-234-0654
Mailing Address - Fax:
Practice Address - Street 1:4987 KERNWOOD CT
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-3614
Practice Address - Country:US
Practice Address - Phone:727-234-0654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS110832085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology