MEDICARE: DAVID HENRI CHANSOLME MD

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	207RI0200X	Infectious Disease Physician	23723	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00174725	OTHER	OK	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457343402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID HENRI CHANSOLME MD

Provider Business Mailing Address
First Line	:	PO BOX 720486
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73070-4357
Country	:	US
Telephone Number	:	405-292-5500
Fax Number	:	405-292-5505

Provider Business Practice Location Address
First Line	:	4221 S WESTERN AVE
Second Line	:	#4010
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3447
Country	:	US
Telephone Number	:	405-644-6464
Fax Number	:	405-644-6465

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	02/04/2015

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Directions to “ DAVID HENRI CHANSOLME MD” Practice Location

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