MEDICARE: DR. CHIEL WIND M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME 17572	FL

General Provider Information

NPI Number	:	1609856681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHIEL WIND M.D

Provider Business Mailing Address
First Line	:	1235 SAN MARCO BLVD
Second Line	:	SUITE 301
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8554
Country	:	US
Telephone Number	:	904-398-2720
Fax Number	:	904-398-6408

Provider Business Practice Location Address
First Line	:	1235 SAN MARCO BLVD
Second Line	:	SUITE 301
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8554
Country	:	US
Telephone Number	:	904-398-2720
Fax Number	:	904-398-6408

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	07/08/2007

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