Individual
MICHAEL JOSEPH CHISAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
(757) 953-2339
Mailing address
NAVAL MEDICAL CENTER CAMP LEJEUNE, 100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2538
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
2020-03385
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/17/2019
Last updated
01/11/2022
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