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General NPI Number Information
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NPI Number | 1538332960
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Entity Type | Organization
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Legal Business Name | PRAIRIE MEDICAL GROUP
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Dates
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Enumeration Date | 04/07/2008
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 8540 S SEPULVEDA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90045-3807
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Country | US
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Telephone | 310-214-8677
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Fax |
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Provider Business Mailing Address
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Address Line | 8540 S SEPULVEDA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90045-3807
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Country | US
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Telephone | 310-214-8677
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Fax |
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | CHRISTOPHER CHIDI
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Credential | MD
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Telephone | 310-214-8677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A53294
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License Number State | CA
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