Provider Demographics
NPI:1144273434
Name:CHISHOLM, DEBORAH GUTHRIE (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:GUTHRIE
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:102 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:IL
Mailing Address - Zip Code:61752-1900
Mailing Address - Country:US
Mailing Address - Phone:309-807-9692
Mailing Address - Fax:309-948-6160
Practice Address - Street 1:102 E CENTER ST
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:IL
Practice Address - Zip Code:61752-1900
Practice Address - Country:US
Practice Address - Phone:309-807-9692
Practice Address - Fax:309-948-6160
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.118448207Q00000X
IA36549207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine