Provider Demographics
NPI:1194705442
Name:FAIDLEY, CHERYL KAY (MD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:KAY
Last Name:FAIDLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6866
Mailing Address - Country:US
Mailing Address - Phone:309-762-9800
Mailing Address - Fax:309-764-3871
Practice Address - Street 1:4300 7TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6866
Practice Address - Country:US
Practice Address - Phone:309-762-9800
Practice Address - Fax:309-764-3871
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-079956207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL98742OtherBCBS
IL036079956Medicaid
IL036079956Medicaid