MEDICARE: KIRAN CHAVDA 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	2085R0202X	Diagnostic Radiology Physician	OS11083	FL
2	2085R0204X	Vascular & Interventional Radiology Physician	OS11083	FL

General Provider Information

NPI Number	:	1912228131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRAN CHAVDA D.O

Provider Business Mailing Address
First Line	:	120 KEYSTONE PALMS BLVD
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34688-7718
Country	:	US
Telephone Number	:	917-293-2438
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 KEYSTONE PALMS BLVD
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34688-7718
Country	:	US
Telephone Number	:	917-293-2438
Fax Number	:

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

Provider Enumeration Date	:	06/22/2010
Last Update Date	:	03/26/2026

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