Provider Demographics
NPI:1205331097
Name:CHEESMAN, NICOLAS DONALD (MD)
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:DONALD
Last Name:CHEESMAN
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 1:8181 E TUFTS AVE STE 560
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2559
Mailing Address - Country:US
Mailing Address - Phone:720-669-3470
Mailing Address - Fax:720-669-3480
Practice Address - Street 1:8181 E TUFTS AVE STE 560
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2559
Practice Address - Country:US
Practice Address - Phone:720-669-3470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01086516A207R00000X
390200000X
CODR.00681111208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program