Provider Demographics
NPI:1720656408
Name:CHIRRAVURI, JAI (MD)
Entity type:Individual
Prefix:
First Name:JAI
Middle Name:
Last Name:CHIRRAVURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 OLD BANK RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-2443
Mailing Address - Country:US
Mailing Address - Phone:513-248-0100
Mailing Address - Fax:513-248-4334
Practice Address - Street 1:201 OLD BANK RD STE 103
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-2443
Practice Address - Country:US
Practice Address - Phone:513-248-0100
Practice Address - Fax:513-248-4334
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.152250207Q00000X
NDRL17377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine