Provider Demographics
NPI:1275844003
Name:CHI, ANDY VICTOR (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANDY
Middle Name:VICTOR
Last Name:CHI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:700 8TH AVE W
Mailing Address - Street 2:STE 101
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4737
Mailing Address - Country:US
Mailing Address - Phone:941-776-4008
Mailing Address - Fax:941-845-4963
Practice Address - Street 1:300 RIVERSIDE DR E
Practice Address - Street 2:STE 1500
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1008
Practice Address - Country:US
Practice Address - Phone:941-741-3338
Practice Address - Fax:941-714-7484
Is Sole Proprietor?:No
Enumeration Date:2010-06-26
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO3528213ES0103X
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHD503ZMedicare PIN