Healthcare Provider Details

I. General information

NPI: 1861798431
Provider Name (Legal Business Name): RONAK SHIVLALBHAI CHAUDHARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PARK ST
BOWLING GREEN KY
42101-1784
US

IV. Provider business mailing address

201 PARK ST
BOWLING GREEN KY
42101-1759
US

V. Phone/Fax

Practice location:
  • Phone: 270-781-5111
  • Fax: 270-780-0472
Mailing address:
  • Phone: 270-781-5111
  • Fax: 270-780-0472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number46977
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: