Provider Demographics
NPI:1932162682
Name:CHIDIAC, ADIB ANTOINE (MD, PA, FACOG)
Entity Type:Individual
Prefix:MR
First Name:ADIB
Middle Name:ANTOINE
Last Name:CHIDIAC
Suffix:
Gender:M
Credentials:MD, PA, FACOG
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 50461
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33074-0461
Mailing Address - Country:US
Mailing Address - Phone:954-366-6039
Mailing Address - Fax:954-366-6851
Practice Address - Street 1:1600 N FEDERAL HWY STE A
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3229
Practice Address - Country:US
Practice Address - Phone:954-366-6039
Practice Address - Fax:954-366-6851
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043336174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370810100Medicaid
FL370810100Medicaid
FL39167Medicare PIN