Provider Demographics
NPI:1245466986
Name:GARY C CHIERICO MD PA
Entity type:Organization
Organization Name:GARY C CHIERICO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:CHIERICO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-785-7013
Mailing Address - Street 1:PO BOX 30250
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33303-0250
Mailing Address - Country:US
Mailing Address - Phone:305-785-7013
Mailing Address - Fax:
Practice Address - Street 1:1100 NW 95TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2038
Practice Address - Country:US
Practice Address - Phone:305-785-7013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049242207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA99075Medicare UPIN