Individual
JOHN WILLIAM CHEESEBRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
2805 CAMPUS DR STE 225, PLYMOUTH, MN 55441-2678
(612) 788-8778
(612) 869-3473
Mailing address
6625 LYNDALE AVE S STE 300, RICHFIELD, MN 55423-2491
(612) 788-8778
(612) 869-3473
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
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