Provider Demographics
NPI:1760493464
Name:CHI, JOSEPH ISAAC (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ISAAC
Last Name:CHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 NW 95TH ST
Mailing Address - Street 2:STE 401
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-2067
Mailing Address - Country:US
Mailing Address - Phone:305-691-1820
Mailing Address - Fax:305-694-8450
Practice Address - Street 1:1210 NW 95 ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147
Practice Address - Country:US
Practice Address - Phone:305-691-1820
Practice Address - Fax:305-694-8450
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57219207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063871400Medicaid
FL10919Medicare ID - Type Unspecified
FL063871400Medicaid