Provider Demographics
NPI:1336534122
Name:CHIDI, PROMISE
Entity type:Individual
Prefix:
First Name:PROMISE
Middle Name:
Last Name:CHIDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PROMISE
Other - Middle Name:
Other - Last Name:ANNANDIKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:27800 NORTHWEST FWY STE 4201
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5302
Mailing Address - Country:US
Mailing Address - Phone:346-231-4628
Mailing Address - Fax:
Practice Address - Street 1:27800 NORTHWEST FWY STE 4201
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-5302
Practice Address - Country:US
Practice Address - Phone:346-231-4628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.38435207P00000X
GA78444207Q00000X, 207QA0505X, 207Q00000X
TXU0980207Q00000X
GA078444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA078444OtherGEORGIA LICENCE