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General NPI Number Information
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NPI Number | 1134160021
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Entity Type | Individual
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Provider Name | ELIE JOSEPH CHIDIAC M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 2006 HOGBACK RD STE 5A
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City | ANN ARBOR
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State | MI
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Zip | 48105-9750
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Country | US
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Telephone | 734-263-2417
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Fax |
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Provider Business Mailing Address
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Address Line | 525 LINDEN CT
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City | NORTHVILLE
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State | MI
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Zip | 48167-1447
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Country | US
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Telephone | 248-302-1992
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME165275
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 4301047411
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License Number State | MI
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