MEDICARE: DR. ALI CHAHLAVI 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	207T00000X	Neurological Surgery Physician	ME95578	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME95578	OTHER	FL	MEDICAL LICENSE

General Provider Information

NPI Number	:	1336198209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALI CHAHLAVI M.D.

Provider Business Mailing Address
First Line	:	4205 BELFORT RD
Second Line	:	JOE ADAMS BUILDING SUITE 1100
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-1471
Country	:	US
Telephone Number	:	904-296-3103
Fax Number	:	904-296-3106

Provider Business Practice Location Address
First Line	:	4205 BELFORT RD
Second Line	:	JOE ADAMS BUILDING SUITE 1100
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-5876
Country	:	US
Telephone Number	:	904-296-3103
Fax Number	:	904-296-3106

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

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	05/28/2014

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