National Provider Identifier Database

PRAIRIE MEDICAL GROUP INC
Specialist

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.


Contact Information

PRAIRIE MEDICAL GROUP INC
10100 CULVER BLVD
CULVER CITY, CA90231
Phone: 310-280-2700
Fax: 310-837-7334
Website:
Specialty Taxonomy Code
* Specialist 174400000X

* Indicates primary specialty

NPI Profile & details for PRAIRIE MEDICAL GROUP INC

NPI Number 1043356272
Legal business name
LBN
PRAIRIE MEDICAL GROUP INC
Authorized official CHRISTOPHER CHIDI - (PRESIDENT)
Entity Organization
Organization subpart No
Enumeration date 01/29/2007
Last updated 08/22/2020 - About 6 years ago
Sole proprietor1 Not specified
Identifiers
  • CA License #: 058963
  • CA Medicaid: GR0078673

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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