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General NPI Number Information
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NPI Number | 1780906339
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE POINT OB/GYN,PLLC
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Dates
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Enumeration Date | 02/24/2010
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Last Update Date | 03/04/2010
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Provider Practice Location Address
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Address Line | 601 E SAMPLE RD SUITE 103
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City | POMPANO BEACH
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State | FL
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Zip | 33064-4443
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Country | US
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Telephone | 954-781-0180
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Fax | 954-781-3230
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Provider Business Mailing Address
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Address Line | 601 E SAMPLE RD
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City | DEERFIELD BEACH
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State | FL
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Zip | 33064-4443
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Country | US
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Telephone | 954-781-0180
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Fax | 954-781-3230
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Authorized Official
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Title or Position | M.D.
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Name | ADIB A CHIDIAC
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Credential |
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Telephone | 954-781-0180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME43336
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License Number State | FL
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