Provider Demographics
NPI:1952367534
Name:CHEATUM, PAUL HENRY (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:HENRY
Last Name:CHEATUM
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 1:15 S LYNWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:EASTBOROUGH
Mailing Address - State:KS
Mailing Address - Zip Code:67207-1037
Mailing Address - Country:US
Mailing Address - Phone:316-558-8041
Mailing Address - Fax:
Practice Address - Street 1:10096 E 13TH ST N
Practice Address - Street 2:STE 144
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2645
Practice Address - Country:US
Practice Address - Phone:316-634-6622
Practice Address - Fax:316-630-9461
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0428268202K00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI468227Medicare ID - Type Unspecified
KS103834Medicare ID - Type UnspecifiedKANSAS MEDICARE
WI415026Medicare ID - Type Unspecified
H08698Medicare UPIN