Provider Demographics
NPI:1316965700
Name:MCCLAIN, CHERYL A (MD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:MCCLAIN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:A
Other - Last Name:KOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:843-277-9070
Practice Address - Street 1:601 VERSAILLES RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-3857
Practice Address - Country:US
Practice Address - Phone:502-695-3946
Practice Address - Fax:502-695-3847
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ71761207QA0401X
OH35C.001086207QA0401X
KY32948207QA0401X
IN01091882A207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64329485Medicaid
KY37903705OtherMEDICAID LAB GROUP
KY4000501OtherMEDICARE LAB GROUP
CB5773OtherRR MEDICARE GROUP
080161176OtherRR MEDICARE PIN
KY00637030Medicare PIN
KY64329485Medicaid