Provider Demographics
NPI:1780906339
Name:LIGHTHOUSE POINT OB/GYN,PLLC
Entity type:Organization
Organization Name:LIGHTHOUSE POINT OB/GYN,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:ADIB
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHIDIAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-781-0180
Mailing Address - Street 1:601 E SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-4443
Mailing Address - Country:US
Mailing Address - Phone:954-781-0180
Mailing Address - Fax:954-781-3230
Practice Address - Street 1:601 E SAMPLE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-4443
Practice Address - Country:US
Practice Address - Phone:954-781-0180
Practice Address - Fax:954-781-3230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43336174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370810100Medicaid
FLE12069Medicare UPIN