Healthcare Provider Details

I. General information

NPI: 1255585659
Provider Name (Legal Business Name): THOMAS PATRICK CHISHOLM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2008
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 W SPRUCE ST
CHIPPEWA FALLS WI
54729-1734
US

IV. Provider business mailing address

316 W SPRUCE ST
CHIPPEWA FALLS WI
54729-1734
US

V. Phone/Fax

Practice location:
  • Phone: 715-726-0365
  • Fax: 715-720-4656
Mailing address:
  • Phone: 715-726-0365
  • Fax: 715-720-4656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number14077-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: