Provider Demographics
NPI:1245440056
Name:DAVID H CHANSOLME MD PC
Entity type:Organization
Organization Name:DAVID H CHANSOLME MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHANSOLME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-644-6464
Mailing Address - Street 1:PO BOX 720486
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-4357
Mailing Address - Country:US
Mailing Address - Phone:405-644-6464
Mailing Address - Fax:405-644-6465
Practice Address - Street 1:4221 S WESTERN AVE
Practice Address - Street 2:SUITE 4010
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3447
Practice Address - Country:US
Practice Address - Phone:405-644-6464
Practice Address - Fax:405-644-6465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23723207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200033350AMedicaid
OKH03796Medicare UPIN
OK200033350AMedicaid