# ADIB ANTOINE CHIDIAC, M.D., P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215057922
- **Authorized official:** DR. ADIB ANTOINE CHIDIAC M.D. (DOCTOR)
- **Authorized official phone:** (954) 366-6039

## Contact information

- **Practice address:** 601 E SAMPLE RD STE 103, DEERFIELD BEACH, FL 33064-4443
- **Practice address phone:** (954) 366-6039
- **Practice address fax:** (954) 366-6851
- **Mailing address:** 3700 NE 31ST AVE, LIGHTHOUSE POINT, FL 33064-8431
- **Mailing address phone:** (954) 366-6039
- **Mailing address fax:** (954) 366-6851

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/29/2007
- **Last updated:** 05/15/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 370810100 | — | FL |
| 01 | — | 39167 | PTAN | FL |