Healthcare Provider Details

I. General information

NPI: 1205122074
Provider Name (Legal Business Name): SMITH ANN MEILE CHISHOLM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SMITH ANN MEILE RASMUSSEN

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-2020
  • Fax: 414-266-2027
Mailing address:
  • Phone: 414-266-2020
  • Fax: 414-266-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number65775
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: