MEDICARE: MR. THOMAS NEIL CHISHOLM M.D.

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
1	207Q00000X	Family Medicine Physician	25364	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00064924	OTHER	CO	MEDICARE RAIL ROAD ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	29599	OTHER	CO	ANTHEM BC/BS PROVIDER ID
4	4137337	OTHER	CO	AETNA HMO PROVIDER ID
5	870689258002	OTHER	CO	ROCKY MOUNTAIN HMO ID
6	870689258002	OTHER	CO	PACIFICARE HMO ID

General Provider Information

NPI Number	:	1306846688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS NEIL CHISHOLM M.D.

Provider Business Mailing Address
First Line	:	3540 S POPLAR ST
Second Line	:	SUITE 200
City	:	DENVER
State	:	CO
Zip	:	80237-1362
Country	:	US
Telephone Number	:	303-226-0013
Fax Number	:	303-757-6148

Provider Business Practice Location Address
First Line	:	3540 S POPLAR ST
Second Line	:	SUITE 200
City	:	DENVER
State	:	CO
Zip	:	80237-1362
Country	:	US
Telephone Number	:	303-226-0013
Fax Number	:	303-757-6148

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	02/20/2008

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Directions to “ MR. THOMAS NEIL CHISHOLM M.D.” Practice Location

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