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Organization
PRAIRIE MEDICAL GROUP
Active
Organization
PRAIRIE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER CHIDI MD (OWNER PRESIDENT)
(310) 214-8677
Entity
Organization
Contact information
Practice address
8540 S SEPULVEDA BLVD, LOS ANGELES, CA 90045-3807
(310) 214-8677
Mailing address
8540 S SEPULVEDA BLVD, LOS ANGELES, CA 90045-3807
(310) 214-8677
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A53294
CA
Other
Enumeration date
04/07/2008
Last updated
04/07/2008
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