Provider Demographics
NPI:1962795948
Name:DAVE, SVARIT (MD)
Entity type:Individual
Prefix:
First Name:SVARIT
Middle Name:
Last Name:DAVE
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 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-272-5395
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:9880 ANGIES WAY STE 420
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2850
Practice Address - Country:US
Practice Address - Phone:502-394-6200
Practice Address - Fax:502-394-6210
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2730390200000X
KY46377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01191479OtherRAILROAD MEDICARE
KY7100216460Medicaid
KY7100216460Medicaid
KYP01191479OtherRAILROAD MEDICARE
KYK056620Medicare PIN