Provider Demographics
NPI:1275754459
Name:CHAILLE, THOMAS B (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:B
Last Name:CHAILLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 NE 54TH ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2967
Mailing Address - Country:US
Mailing Address - Phone:305-757-8260
Mailing Address - Fax:
Practice Address - Street 1:375 NE 54TH ST
Practice Address - Street 2:SUITE #2
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2967
Practice Address - Country:US
Practice Address - Phone:305-757-8260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS00004657207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0699144Medicaid
FL0699144Medicaid
FLD27383Medicare UPIN