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1366460941
MAXI THEODORINE CHOUSAND
FORT WORTH, TX
NPI
1366460941
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Former Name
MEIHATI SOEMIJARSIH
Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
207R00000X Internal Medicine
(Licence: TX K8078)
Enumeration Date
2006-07-18
Last Update Date
2007-07-08
Business Address
MAXI THEODORINE CHOUSAND M.D.
300 W ROSEDALE ST
FORT WORTH, TX 76104-4856
Phone number: 817-882-6003
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Mailing Address
MAXI THEODORINE CHOUSAND M.D.
2561 GREEN OAK DR
CARROLLTON, TX 75010-4224
Phone number: 972-307-9116
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