Provider Demographics
NPI:1154316727
Name:CHIDAMBARAM, ARUL B (MD)
Entity Type:Individual
Prefix:DR
First Name:ARUL
Middle Name:B
Last Name:CHIDAMBARAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6415 LAKE WORTH RD STE 102
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3009
Mailing Address - Country:US
Mailing Address - Phone:561-331-0808
Mailing Address - Fax:561-798-9282
Practice Address - Street 1:12955 PALMS WEST DR STE 101
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9212
Practice Address - Country:US
Practice Address - Phone:561-798-1515
Practice Address - Fax:561-798-9282
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79993208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260225300Medicaid
FL260225300Medicaid
H24353Medicare UPIN