Provider Demographics
NPI:1245241280
Name:CHAYKIN, LOUIS B (MD, FACE)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:B
Last Name:CHAYKIN
Suffix:
Gender:M
Credentials:MD, FACE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 919306
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-9306
Mailing Address - Country:US
Mailing Address - Phone:941-907-0588
Mailing Address - Fax:941-373-6622
Practice Address - Street 1:1900 BROTHER GEENEN WAY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7102
Practice Address - Country:US
Practice Address - Phone:941-556-3220
Practice Address - Fax:941-955-8214
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0012244174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13497Medicare ID - Type UnspecifiedID
FLD52278Medicare UPIN
FL13497VMedicare UPIN
FL13497XMedicare PIN