Basic Information
| Provider Information | |||||||||
| NPI: | 1588621254 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAUHAN | ||||||||
| FirstName: | RAVI | ||||||||
| MiddleName: | DINESH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1325 WOLF PARK DR | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381381742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012523411 | ||||||||
| FaxNumber: | 9013846422 | ||||||||
| Practice Location | |||||||||
| Address1: | 1325 WOLF PARK DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381381742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012523400 | ||||||||
| FaxNumber: | 9016820047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 208800000X | 37352 | TN | Y | Allopathic & Osteopathic Physicians | Urology | 208800000X | 18832 | MS | N | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 35171 | 01 | TLC TENNCARE | OTHER | 4101363 | 01 | TN | BLUE CROSS | OTHER | 05090011800 | 01 | QUAL CHOICE | OTHER | 3330782 | 01 | TENNCARE (ALL OTHER PLANS | OTHER | 3330782 | 05 | TN | MEDICAID | 13427577 | 01 | PHCS | OTHER | 4101363 | 01 | TENNCARE SELECT | OTHER | 211159 | 01 | SOUTHERN HEALTH SERVICES | OTHER | 5656234 | 01 | FIRST HEALTH | OTHER | 7876654 | 01 | AETNA | OTHER | 9640627 | 01 | CIGNA | OTHER |