Individual
PHILLIP RUBEN CHISHOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226
(414) 955-6830
(414) 955-6214
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 955-6830
(414) 955-6214
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2011015256
MO
207RG0100X
Gastroenterology Physician
Primary
69482
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356636278
—
WI
Enumeration date
06/20/2011
Last updated
07/05/2018
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