Healthcare Provider Details

I. General information

NPI: 1346460573
Provider Name (Legal Business Name): CHEETHAM & LUI PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9162 ESTATE THOMAS BAY 10
ST THOMAS VI
00802-2687
US

IV. Provider business mailing address

9162 ESTATE THOMAS BAY 10
ST THOMAS VI
00802-2687
US

V. Phone/Fax

Practice location:
  • Phone: 340-774-1080
  • Fax: 340-774-9842
Mailing address:
  • Phone: 340-774-1080
  • Fax: 340-774-9842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number848
License Number StateVI

VIII. Authorized Official

Name: MS. ANGELA W LUI
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 340-774-1080