Individual
THELMA LOUISE CHISHOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1600 LAKELAND HILLS BLVD, LAKELAND, FL 33805
(863) 680-7000
(866) 264-8519
Mailing address
PO BOX 95004, LAKELAND, FL 33804
(863) 680-7206
(863) 680-7420
Taxonomy
Speciality
Code
Description
License number
State
2085R0203X
Therapeutic Radiology Physician
Primary
ME85941
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
265428800
—
FL
Enumeration date
01/27/2006
Last updated
06/12/2012
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