Healthcare Provider Details

I. General information

NPI: 1073596524
Provider Name (Legal Business Name): MICHELE M CHETHAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 E HAMPDEN AVE
ENGLEWOOD CO
80113-2506
US

IV. Provider business mailing address

180 E HAMPDEN AVE
ENGLEWOOD CO
80113-2506
US

V. Phone/Fax

Practice location:
  • Phone: 303-789-4968
  • Fax: 303-789-6018
Mailing address:
  • Phone: 303-789-4968
  • Fax: 303-789-6018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number31736
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31736
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: