Provider Demographics
NPI:1912054297
Name:MBAERI, CHINYERE CHRIS (MD)
Entity Type:Individual
Prefix:
First Name:CHINYERE
Middle Name:CHRIS
Last Name:MBAERI
Suffix:
Gender:M
Credentials:MD
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 212138
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33421-2138
Mailing Address - Country:US
Mailing Address - Phone:561-623-0801
Mailing Address - Fax:561-469-1928
Practice Address - Street 1:10111 FOREST HILL BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6108
Practice Address - Country:US
Practice Address - Phone:561-623-0801
Practice Address - Fax:561-469-1928
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101902207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0727412Medicaid
FL000346900Medicaid
IA0727412Medicaid