Provider Demographics
NPI:1215215850
Name:PAVITAR S.CHEEMA, M.D. PA
Entity Type:Organization
Organization Name:PAVITAR S.CHEEMA, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAVITAR
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHEEMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-788-7641
Mailing Address - Street 1:38023 MEDICAL CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33540-1384
Mailing Address - Country:US
Mailing Address - Phone:813-788-7641
Mailing Address - Fax:813-782-1980
Practice Address - Street 1:38023 MEDICAL CENTER AVENUE
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540-1384
Practice Address - Country:US
Practice Address - Phone:813-788-7641
Practice Address - Fax:813-782-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0038130208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067139800Medicaid
FL340002758OtherRR MEDICARE
FL067139800Medicaid
FL340002758OtherRR MEDICARE