Healthcare Provider Details

I. General information

NPI: 1780906339
Provider Name (Legal Business Name): LIGHTHOUSE POINT OB/GYN,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E SAMPLE RD SUITE 103
POMPANO BEACH FL
33064-4443
US

IV. Provider business mailing address

601 E SAMPLE RD
DEERFIELD BEACH FL
33064-4443
US

V. Phone/Fax

Practice location:
  • Phone: 954-781-0180
  • Fax: 954-781-3230
Mailing address:
  • Phone: 954-781-0180
  • Fax: 954-781-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME43336
License Number StateFL

VIII. Authorized Official

Name: ADIB A CHIDIAC
Title or Position: M.D.
Credential:
Phone: 954-781-0180