Healthcare Provider Details

I. General information

NPI: 1598797318
Provider Name (Legal Business Name): DOMINGO CHELEUITTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E GRANT RD BLDG 1
TUCSON AZ
85712-2805
US

IV. Provider business mailing address

PO BOX 31630
TUCSON AZ
85751-1630
US

V. Phone/Fax

Practice location:
  • Phone: 520-784-6200
  • Fax: 520-784-6109
Mailing address:
  • Phone: 520-784-6200
  • Fax: 520-784-6109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number31374
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: