Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | ME70768 | FL |
N | 208600000X | Surgeon | ME70768 | FL |
Y | 2086S0102X | Surgical Critical Care | ME70768 | FL |
NPI | 1326027749 |
---|---|
Provider Name | Michael L Cheatham |
First Address | Orlando, FL 32806-1122 |
Second Address | Orlando, FL 32806-1122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 10/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
251067700 | (05) | FL |
ME70768 | MEDICAL LICENSE (01) | FL |