MEDICARE: DEMETRIUS CHEEKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	323318560512	OH

General Provider Information

NPI Number	:	1225387756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEMETRIUS CHEEKS

Provider Business Mailing Address
First Line	:	1234 E 173RD ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44119-3133
Country	:	US
Telephone Number	:	216-315-4966
Fax Number	:

Provider Business Practice Location Address
First Line	:	1234 E 173RD ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44119-3133
Country	:	US
Telephone Number	:	216-315-4966
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2012
Last Update Date	:	08/30/2012

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Directions to “ DEMETRIUS CHEEKS ” Practice Location

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