1598795270 NPI number — MICHAEL D CHIDESTER, MD.,P.A.

Table of content: (NPI 1598795270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598795270 NPI number — MICHAEL D CHIDESTER, MD.,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL D CHIDESTER, MD.,P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598795270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3375 BURNS RD
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
PALM BEACH GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33410-4349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-355-8388
Provider Business Mailing Address Fax Number:
561-355-8348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3375 BURNS RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
PALM BEACH GARDENS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33410-4349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-355-8388
Provider Business Practice Location Address Fax Number:
561-355-8348
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHIDESTER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
561-355-8388

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME52189 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 048740600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com