Provider Demographics
NPI:1508291956
Name:CHISESI, DIANE (NFS MD PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:CHISESI
Suffix:
Gender:F
Credentials:NFS MD PHD
Other - Prefix:PROF
Other - First Name:USCMDR DIANE
Other - Middle Name:
Other - Last Name:CHISESI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CEO, MD PHD
Mailing Address - Street 1:P.O. BOX 6936
Mailing Address - Street 2:2517 B. KING STREET
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904
Mailing Address - Country:US
Mailing Address - Phone:719-477-0295
Mailing Address - Fax:
Practice Address - Street 1:2517 B. KING STREET
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904
Practice Address - Country:US
Practice Address - Phone:719-477-0295
Practice Address - Fax:719-477-0295
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO218974772207L00000X, 207P00000X, 207ZF0201X, 207ZH0000X, 2080P0204X, 2086X0206X
CO218974772UA208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic PathologyGroup - Single Specialty
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO218974772OtherDHP/HSSA/DSS