Provider Demographics
NPI:1457517849
Name:CHIDI, VIVIAN NKEM
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:NKEM
Last Name:CHIDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:541-732-8500
Mailing Address - Fax:
Practice Address - Street 1:1698 E MCANDREWS RD
Practice Address - Street 2:STE 170
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5589
Practice Address - Country:US
Practice Address - Phone:541-732-8500
Practice Address - Fax:541-732-8501
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH126377207R00000X
ORMD181130207RG0100X
PAMT195484207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology