MEDICARE: AULTON DALE CHISUM DO

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	207P00000X	Emergency Medicine Physician	2005026115	MO
2	207P00000X	Emergency Medicine Physician	F1449	TX

General Provider Information

NPI Number	:	1437131208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AULTON DALE CHISUM DO

Provider Business Mailing Address
First Line	:	15954 S BROUGHAM DR
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-7044
Country	:	US
Telephone Number	:	913-780-6320
Fax Number	:	913-469-1441

Provider Business Practice Location Address
First Line	:	1509 W TRUMAN RD
Second Line	:	EMERGENCY DEPARTMENT
City	:	INDEPENDENCE
State	:	MO
Zip	:	64050-3436
Country	:	US
Telephone Number	:	913-469-1488
Fax Number	:	913-469-1441

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	07/08/2007

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Directions to “ AULTON DALE CHISUM DO” Practice Location

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