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NPI Code Detail

MEDICARE: MARCUS CHISHOLM

MEDICARE: MARCUS CHISHOLM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1164380382
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARCUS CHISHOLM
Provider Business Mailing Address
First Line : 398 W BAGLEY RD
Second Line :
City : BEREA
State : OH
Zip : 44017-1369
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9655 SWEET VALLEY DR
Second Line :
City : CLEVELAND
State : OH
Zip : 44125-4270
Country : US
Telephone Number : 216-340-0011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2026
Last Update Date : 01/15/2026

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Directions to “ MARCUS CHISHOLM ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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