Provider Demographics
NPI:1881672012
Name:CHEEMA, MOHINDER SINGH (MD)
Entity Type:Individual
Prefix:
First Name:MOHINDER
Middle Name:SINGH
Last Name:CHEEMA
Suffix:
Gender:M
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:PO BOX 55609
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-0609
Mailing Address - Country:US
Mailing Address - Phone:206-919-7745
Mailing Address - Fax:
Practice Address - Street 1:4740 NE 203RD ST
Practice Address - Street 2:
Practice Address - City:LAKE FOREST PARK
Practice Address - State:WA
Practice Address - Zip Code:98155-1824
Practice Address - Country:US
Practice Address - Phone:206-919-7745
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013615207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1152107Medicaid
A07130Medicare UPIN