MEDICARE: JORGE CARLOS CHELEUITTE SEMIDEY M.D.

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	208D00000X	General Practice Physician	021224	PR

General Provider Information

NPI Number	:	1972039790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE CARLOS CHELEUITTE SEMIDEY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1842
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00970
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1395 SAN RAFAEL
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00910-3428
Country	:	US
Telephone Number	:	787-999-7620
Fax Number	:

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

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	11/06/2020

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