Provider Demographics
NPI:1275532954
Name:CHERUKURI, RADHA (MD)
Entity type:Individual
Prefix:DR
First Name:RADHA
Middle Name:
Last Name:CHERUKURI
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 1:1000 HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5303
Mailing Address - Country:US
Mailing Address - Phone:989-746-7500
Mailing Address - Fax:989-746-7723
Practice Address - Street 1:1000 HOUGHTON AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5303
Practice Address - Country:US
Practice Address - Phone:989-746-7500
Practice Address - Fax:989-746-7723
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2024-10-23
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
MIRC051733174400000X
174400000X
MI4301051733207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1607310061OtherBCBS PIN
MI1607310061OtherBCN PIN
MI1275532954Medicaid
MI562342902100OtherHEALTH PLUS ID
MI1275532954OtherMEDICARE BILLING PROVIDER
MI1275532954Medicaid
MI1275532954OtherMEDICARE BILLING PROVIDER