MEDICARE: JAY K. CHAUHAN D.O.

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	207YS0123X	Facial Plastic Surgery Physician	036086823	IL
2	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	036086823	IL
3	207Y00000X	Otolaryngology Physician	036086823	IL

General Provider Information

NPI Number	:	1639170731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY K. CHAUHAN D.O.

Provider Business Mailing Address
First Line	:	611 W. PARK ST
Second Line	:	FAPC
City	:	URBANA
State	:	IL
Zip	:	61801
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 LANDMARK DR
Second Line	:
City	:	NORMAL
State	:	IL
Zip	:	61761-3195
Country	:	US
Telephone Number	:	309-268-3200
Fax Number	:

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	05/19/2022

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