Provider Demographics
NPI:1831490457
Name:JOSEPH CHI MD PA
Entity Type:Organization
Organization Name:JOSEPH CHI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:CHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-691-1820
Mailing Address - Street 1:1210 NW 95TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-3318
Mailing Address - Country:US
Mailing Address - Phone:305-691-1820
Mailing Address - Fax:305-694-8450
Practice Address - Street 1:1210 NW 95TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-3318
Practice Address - Country:US
Practice Address - Phone:305-691-1820
Practice Address - Fax:305-694-8450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57219207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0638714Medicaid
FLE58292Medicare UPIN