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General NPI Number Information
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NPI Number | 1063996288
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Entity Type | Individual
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Provider Name | MATTHEW STEVEN CHERNIKOVICH PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/24/2018
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Last Update Date | 09/24/2018
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Provider Practice Location Address
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Address Line | 5134 N NEVADA AVE STE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-8699
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Country | US
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Telephone | 719-598-5698
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Fax |
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Provider Business Mailing Address
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Address Line | 6284 TWIN OAKS DR APT 2222
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-8329
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Country | US
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Telephone | 630-247-0513
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0005468
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License Number State | CO
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