Provider Demographics
NPI:1457343402
Name:CHANSOLME, DAVID HENRI (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:HENRI
Last Name:CHANSOLME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:405-292-5500
Mailing Address - Fax:405-292-5505
Practice Address - Street 1:4221 S WESTERN AVE
Practice Address - Street 2:#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
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23723207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200033350AMedicaid
OKP00174725OtherRAILROAD MEDICARE
OK248421101Medicare ID - Type Unspecified
OK200033350AMedicaid