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Organization
PRAIRIE MEDICAL GROUP INC
Active
Organization
PRAIRIE MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER C CHIDI MD (PRESIDENT)
(310) 214-8677
Entity
Organization
Contact information
Practice address
323 N. PRAIRIE AVE, SUITE 460, INGLEWOOD, CA 90301
(310) 674-9010
(310) 677-5072
Mailing address
DEPARTMENT NO 2834, LOS ANGELES, CA 90084
(310) 214-8677
(310) 921-1718
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
05529709
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0078671
—
CA
Enumeration date
01/26/2007
Last updated
08/22/2020
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