Healthcare Provider Details

I. General information

NPI: 1609856681
Provider Name (Legal Business Name): CHIEL WIND M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 SAN MARCO BLVD SUITE 301
JACKSONVILLE FL
32207-8554
US

IV. Provider business mailing address

1235 SAN MARCO BLVD SUITE 301
JACKSONVILLE FL
32207-8554
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-2720
  • Fax: 904-398-6408
Mailing address:
  • Phone: 904-398-2720
  • Fax: 904-398-6408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME 17572
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: