MEDICARE: GEORGE WILLIAM 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	174400000X	Specialist	FL-035767	FL

General Provider Information

NPI Number	:	1952600546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE WILLIAM CHISHOLM, M.D.

Provider Business Mailing Address
First Line	:	1720 S ORANGE AVE
Second Line	:	SUITE 102
City	:	ORLANDO
State	:	FL
Zip	:	32806-2945
Country	:	US
Telephone Number	:	407-841-1521
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 S ORANGE AVE
Second Line	:	SUITE 102
City	:	ORLANDO
State	:	FL
Zip	:	32806-2945
Country	:	US
Telephone Number	:	407-841-1521
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	DR. GEORGE WILLIAM CHISHOLM
Credential	:	M.D.
Telephone Number	:	407-841-1521

Provider Enumeration Date	:	03/22/2011
Last Update Date	:	03/22/2011

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