Healthcare Provider Details

I. General information

NPI: 1164085999
Provider Name (Legal Business Name): RODY GEORGES BOU CHAAYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 DUNLAWTON AVE STE A
PORT ORANGE FL
32127-4224
US

IV. Provider business mailing address

645 DIVISION ST APT 1809
NASHVILLE TN
37203-6415
US

V. Phone/Fax

Practice location:
  • Phone: 734-718-8216
  • Fax:
Mailing address:
  • Phone: 734-718-8216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberU4471
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME183118
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: