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General NPI Number Information
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NPI Number | 1598795270
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Entity Type | Organization
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Legal Business Name | MICHAEL D CHIDESTER, MD.,P.A.
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 07/09/2010
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Provider Practice Location Address
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Address Line | 3375 BURNS RD SUITE 204
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4349
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Country | US
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Telephone | 561-355-8388
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Fax | 561-355-8348
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Provider Business Mailing Address
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Address Line | 3375 BURNS RD SUITE 204
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4349
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Country | US
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Telephone | 561-355-8388
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Fax | 561-355-8348
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Authorized Official
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Title or Position | OFFICER
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Name | DR. MICHAEL D CHIDESTER
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Credential | M.D.
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Telephone | 561-355-8388
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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 | ME52189
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License Number State | FL
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