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Contact Information

JOHN W CHEESEBRO, DPM
2805 CAMPUS DR STE 225
PLYMOUTH, MN55441-2678
 Phone: 612-788-8778
 Fax: 612-869-3473
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Podiatrist

213E00000X 48 Podiatry
Indicates primary specialty

NPI Profile & details for JOHN W CHEESEBRO · (Male)

NPI # 1144333667
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 08/17/2006
Last updated 07/22/2019 - About 7 years ago
Sole proprietor 1 Yes
Identifiers
  • MN License # 366
  • MN Medicaid 323225500
  • MI Other 11691MI BC/BS PROVIDER ID
  • MN Other 0541840001 ADMINISTAR DEFENSE ID
  • MN Other 411695192 FEDERAL TAX ID
  • MN Other HP13053 HEALTHPARTNERS PROVIDER #
  • MN Other 271055 MEDICA PROVIDER ID
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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