Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0011X | Interventional Cardiology | 35081592 | OH |
N | 2080P0202X | Pediatric Cardiologist | 35.081592 | OH |
NPI | 1114926680 |
---|---|
Provider Name | John Patrick Cheatham |
First Address | Columbus, OH 43205-2664 |
Second Address | Columbus, OH 43205-2664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 13/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2004706000 | MEDICAID (01) | WV |
2342496 | (05) | OH |
64057813 | MEDICAID (01) | KY |
E38115 | (02) |