Healthcare Provider Details

I. General information

NPI: 1952367534
Provider Name (Legal Business Name): PAUL HENRY CHEATUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10096 E 13TH ST N STE 144
WICHITA KS
67206-2645
US

IV. Provider business mailing address

15 S LYNWOOD BLVD
EASTBOROUGH KS
67207-1037
US

V. Phone/Fax

Practice location:
  • Phone: 316-634-6622
  • Fax: 316-630-9461
Mailing address:
  • Phone: 316-558-8041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number0428268
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0428268
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: