Provider Demographics
NPI:1194750695
Name:CHAUHAN, UDAY R (MD PA)
Entity type:Individual
Prefix:DR
First Name:UDAY
Middle Name:R
Last Name:CHAUHAN
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:CHAUHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:CHAUHAN MEDICAL CENTER
Mailing Address - Street 2:2720 REBECCA LANE STE 101
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763
Mailing Address - Country:US
Mailing Address - Phone:386-456-5159
Mailing Address - Fax:386-456-0139
Practice Address - Street 1:CHAUHAN MEDICAL CENTER
Practice Address - Street 2:2720 REBECCA LANE STE 101
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763
Practice Address - Country:US
Practice Address - Phone:386-456-5159
Practice Address - Fax:386-456-0139
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73576207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE0561XOtherMEDICARE ID NUMBER
FL261505300Medicaid
FL44760OtherBCBS
FL261505300Medicaid