Organization
CHISHOLM MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM WILSON MD (OWNER)
(218) 254-7476
Entity
Organization
Contact information
Practice address
400 1ST AVE SW, SUITE 1, CHISHOLM, MN 55719-2081
(218) 254-7476
Mailing address
3920 13TH AVE E, SUITE 6, HIBBING, MN 55746-3675
(218) 263-7540
(866) 732-0699
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55A03CH
BCBS
MN
Enumeration date
07/28/2006
Last updated
04/18/2008
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