Provider Demographics
NPI:1528068590
Name:CHILIMIGRAS, ROBERTA M (MD)
Entity type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:M
Last Name:CHILIMIGRAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:WAVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39576-2621
Mailing Address - Country:US
Mailing Address - Phone:228-467-9281
Mailing Address - Fax:228-466-3330
Practice Address - Street 1:200 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:WAVELAND
Practice Address - State:MS
Practice Address - Zip Code:39576-2621
Practice Address - Country:US
Practice Address - Phone:228-467-9281
Practice Address - Fax:228-466-3330
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10599207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00011143Medicaid
MS00011143Medicaid
MS080000685Medicare ID - Type Unspecified