Healthcare Provider Details

I. General information

NPI: 1689610917
Provider Name (Legal Business Name): MELISSA CHEESEMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT JOSEPH DR
LEXINGTON KY
40504-3742
US

IV. Provider business mailing address

509 WHITE CHAPEL CIR
LEXINGTON KY
40509-2920
US

V. Phone/Fax

Practice location:
  • Phone: 859-313-1176
  • Fax:
Mailing address:
  • Phone: 859-543-0159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number28180
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: