Basic Information
| Provider Information | |||||||||
| NPI: | 1073596524 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHETHAM | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4900 S MONACO ST STE 210 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802373487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7209790840 | ||||||||
| FaxNumber: | 3038614741 | ||||||||
| Practice Location | |||||||||
| Address1: | 14000 E ARAPAHOE RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801124045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7209790840 | ||||||||
| FaxNumber: | 3038614741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2005 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0204X | 31736 | CO | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 122626600 | 05 | WY | MEDICAID | 01317361 | 05 | CO | MEDICAID | 007828 | 01 | CO | KAISER COMMERCIAL NUMBER | OTHER |