Provider Demographics
NPI:1215057922
Name:ADIB ANTOINE CHIDIAC, M.D., P.A.
Entity type:Organization
Organization Name:ADIB ANTOINE CHIDIAC, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADIB
Authorized Official - Middle Name:ANTOINE
Authorized Official - Last Name:CHIDIAC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-366-6039
Mailing Address - Street 1:3700 NE 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-8431
Mailing Address - Country:US
Mailing Address - Phone:954-366-6039
Mailing Address - Fax:954-366-6851
Practice Address - Street 1:601 E SAMPLE RD STE 103
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-4443
Practice Address - Country:US
Practice Address - Phone:954-366-6039
Practice Address - Fax:954-366-6851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370810100Medicaid
FL39167OtherPTAN
FL39167Medicare PIN