Individual
JOHN WILLIAM CHEESEBRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
366
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0541840001
ADMINISTAR DEFENSE ID
MN
01
—
11691MI
BC/BS PROVIDER ID
MI
01
—
271055
MEDICA PROVIDER ID
MN
05
—
323225500
—
MN
01
—
411695192
FEDERAL TAX ID
MN
01
—
HP13053
HEALTHPARTNERS PROVIDER #
MN
Enumeration date
08/17/2006
Last updated
07/22/2019
Update your record
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