Provider Demographics
NPI:1164520375
Name:CHISHOLM, KEITH GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:GREGORY
Last Name:CHISHOLM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3152 LITTLE RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1864
Mailing Address - Country:US
Mailing Address - Phone:727-372-0400
Mailing Address - Fax:727-372-0403
Practice Address - Street 1:10751 MAPLE CREEK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4418
Practice Address - Country:US
Practice Address - Phone:727-372-0400
Practice Address - Fax:727-372-0403
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-05-28
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Provider Licenses
StateLicense IDTaxonomies
FLME83998208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery