MEDICARE: DR. THEODORE G CHEKAN D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN12874	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992750426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THEODORE G CHEKAN D.M.D.

Provider Business Mailing Address
First Line	:	PO BOX 82969
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33682-2969
Country	:	US
Telephone Number	:	813-866-0930
Fax Number	:	813-866-0929

Provider Business Practice Location Address
First Line	:	1502 E FOWLER AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-5416
Country	:	US
Telephone Number	:	813-866-0950
Fax Number	:	813-866-0929

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	01/24/2011

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