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General NPI Number Information
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NPI Number | 1366460941
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Entity Type | Individual
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Provider Name | MAXI THEODORINE CHOUSAND M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 300 W ROSEDALE ST
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City | FORT WORTH
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State | TX
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Zip | 76104-4856
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Country | US
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Telephone | 817-882-6003
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Fax |
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Provider Business Mailing Address
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Address Line | 2561 GREEN OAK DR
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City | CARROLLTON
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State | TX
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Zip | 75010-4224
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Country | US
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Telephone | 972-307-9116
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | K8078
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License Number State | TX
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