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Individual

WILLIAM G CHEADLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
401 E CHESTNUT ST, SUITE 710, LOUISVILLE, KY 40202-5700
(502) 583-8303
(502) 584-0302
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0329
(502) 588-0326

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
21560
KY
2086S0102X
Surgical Critical Care Physician
Primary
21560
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100345350A
IN
01
1051079
PASSPORT
KY
05
64215601
KY
Enumeration date
01/12/2006
Last updated
08/10/2016
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