Provider Demographics
NPI:1598795270
Name:MICHAEL D CHIDESTER, MD.,P.A.
Entity Type:Organization
Organization Name:MICHAEL D CHIDESTER, MD.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHIDESTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-355-8388
Mailing Address - Street 1:3375 BURNS RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4349
Mailing Address - Country:US
Mailing Address - Phone:561-355-8388
Mailing Address - Fax:561-355-8348
Practice Address - Street 1:3375 BURNS RD
Practice Address - Street 2:SUITE 204
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4349
Practice Address - Country:US
Practice Address - Phone:561-355-8388
Practice Address - Fax:561-355-8348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52189207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048740600Medicaid
FLK9998Medicare PIN
FLD21003Medicare UPIN