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Organization
PRAIRIE MEDICAL GROUP
Active
Organization
PRAIRIE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER C CHIDI MD (PRESIDENT)
(310) 214-8677
Entity
Organization
Contact information
Practice address
4644 LINCOLN BLVD, SUITE 428, MARINA DEL REY, CA 90292
(310) 214-8677
(310) 921-1718
Mailing address
DEPT 2834, LOS ANGELES, CA 90084
(310) 306-1888
(310) 577-8290
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
058963
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0078675
—
CA
Enumeration date
04/03/2007
Last updated
08/22/2020
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