Provider Demographics
NPI:1396740072
Name:CHISHOLM, JOHN ANGUS (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANGUS
Last Name:CHISHOLM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:345 F ST
Mailing Address - Street 2:STE 100
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2632
Mailing Address - Country:US
Mailing Address - Phone:619-427-3481
Mailing Address - Fax:619-420-7807
Practice Address - Street 1:345 F ST
Practice Address - Street 2:STE 100
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2632
Practice Address - Country:US
Practice Address - Phone:619-427-3481
Practice Address - Fax:619-420-7807
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3431213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E34312Medicaid
CA4894560001Medicare NSC
CAE3431DMedicare ID - Type UnspecifiedMEDICARE PROV NUMBER
CA000E34312Medicaid