Healthcare Provider Details

I. General information

NPI: 1336198209
Provider Name (Legal Business Name): ALI CHAHLAVI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 BELFORT RD JOE ADAMS BUILDING SUITE 1100
JACKSONVILLE FL
32216-5876
US

IV. Provider business mailing address

4205 BELFORT RD JOE ADAMS BUILDING SUITE 1100
JACKSONVILLE FL
32216-1471
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-3103
  • Fax: 904-296-3106
Mailing address:
  • Phone: 904-296-3103
  • Fax: 904-296-3106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME95578
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: