Individual
MICHAEL STEPHEN CHISUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
751 NE BLAKELY DR STE 4020, ISSAQUAH, WA 98029-6201
(425) 313-7124
(425) 313-7072
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
(206) 568-7043
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD61170311
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2084042
—
WA
Enumeration date
03/26/2017
Last updated
12/01/2022
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