Basic Information
| Provider Information | |||||||||
| NPI: | 1336198209 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAHLAVI | ||||||||
| FirstName: | ALI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4205 BELFORT RD | ||||||||
| Address2: | JOE ADAMS BUILDING SUITE 1100 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322161471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042963103 | ||||||||
| FaxNumber: | 9042963106 | ||||||||
| Practice Location | |||||||||
| Address1: | 4205 BELFORT RD | ||||||||
| Address2: | JOE ADAMS BUILDING SUITE 1100 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322165876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042963103 | ||||||||
| FaxNumber: | 9042963106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 05/28/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | ME95578 | FL | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | ME95578 | 01 | FL | MEDICAL LICENSE | OTHER |