MEDICARE: DIVYA CHAUHAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2004000453	MO

General Provider Information

NPI Number	:	1508802976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIVYA CHAUHAN M.D.

Provider Business Mailing Address
First Line	:	11550 OLIVE BLVD
Second Line	:	STE 120
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-7111
Country	:	US
Telephone Number	:	314-523-2590
Fax Number	:	314-590-5943

Provider Business Practice Location Address
First Line	:	11550 OLIVE BLVD
Second Line	:	STE 120
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-7111
Country	:	US
Telephone Number	:	314-523-2590
Fax Number	:	314-590-5943

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	06/05/2013

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