Provider Demographics
NPI:1306846688
Name:CHISHOLM, THOMAS NEIL (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:NEIL
Last Name:CHISHOLM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3540 S POPLAR ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1362
Mailing Address - Country:US
Mailing Address - Phone:303-226-0013
Mailing Address - Fax:303-757-6148
Practice Address - Street 1:3540 S POPLAR ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-1362
Practice Address - Country:US
Practice Address - Phone:303-226-0013
Practice Address - Fax:303-757-6148
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO25364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00064924OtherMEDICARE RAIL ROAD ID
CO01253640Medicaid
CO29599OtherANTHEM BC/BS PROVIDER ID
CO4137337OtherAETNA HMO PROVIDER ID
CO870689258002OtherROCKY MOUNTAIN HMO ID
CO870689258002OtherPACIFICARE HMO ID
CO870689258002OtherPACIFICARE HMO ID
COC508748Medicare PIN