Provider Demographics
NPI:1649215435
Name:CHEBLI, JOSEPH E (MD FACS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:E
Last Name:CHEBLI
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 E VENICE AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-9082
Mailing Address - Country:US
Mailing Address - Phone:941-209-4646
Mailing Address - Fax:941-445-4152
Practice Address - Street 1:1370 E VENICE AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-9082
Practice Address - Country:US
Practice Address - Phone:941-209-4646
Practice Address - Fax:941-445-4152
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043274174400000X
FLME114652208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3267CHOtherREGENCE
WA1122720Medicaid
WA0202216OtherLABOR AND INDUSTRIES
WADD8376OtherMEDICARE RAILROAD
WADD8376OtherMEDICARE RAILROAD
WA3267CHOtherREGENCE