Provider Demographics
NPI:1073596524
Name:CHETHAM, MICHELE M (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:M
Last Name:CHETHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 E HAMPDEN AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2506
Mailing Address - Country:US
Mailing Address - Phone:303-789-4968
Mailing Address - Fax:303-789-6018
Practice Address - Street 1:180 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2506
Practice Address - Country:US
Practice Address - Phone:303-789-4968
Practice Address - Fax:303-789-6018
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO317362080P0204X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01317361Medicaid
WY122626600Medicaid
CO007828OtherKAISER COMMERCIAL NUMBER
CO318755YLK2Medicare UPIN
COE57574Medicare UPIN
COCOA108398Medicare UPIN