Healthcare Provider Details

I. General information

NPI: 1912054297
Provider Name (Legal Business Name): CHINYERE CHRIS MBAERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10111 FOREST HILL BLVD SUITE 320
WELLINGTON FL
33414-6108
US

IV. Provider business mailing address

PO BOX 212138
ROYAL PALM BEACH FL
33421-2138
US

V. Phone/Fax

Practice location:
  • Phone: 561-623-0801
  • Fax: 561-469-1928
Mailing address:
  • Phone: 561-623-0801
  • Fax: 561-469-1928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME101902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: