MEDICARE: DR. CRAIG WILLIS CHAVEZ 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	2085R0202X	Diagnostic Radiology Physician	4301105269	MI
2	2085R0204X	Vascular & Interventional Radiology Physician	2019-00063	NC

General Provider Information

NPI Number	:	1790199107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG WILLIS CHAVEZ M.D

Provider Business Mailing Address
First Line	:	PO BOX 750243
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45475-0243
Country	:	US
Telephone Number	:	937-709-5051
Fax Number	:	937-709-5050

Provider Business Practice Location Address
First Line	:	1 WYOMING ST STE 4120
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45409-2722
Country	:	US
Telephone Number	:	937-499-7364
Fax Number	:

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

Provider Enumeration Date	:	06/13/2014
Last Update Date	:	04/22/2025

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