Provider Demographics
NPI:1992858690
Name:HAJEK, CHERYL GREEN (MD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:GREEN
Last Name:HAJEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 13133
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98082
Mailing Address - Country:US
Mailing Address - Phone:425-408-2536
Mailing Address - Fax:425-939-1614
Practice Address - Street 1:17921 BOTHELL EVERETT HIGHWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012
Practice Address - Country:US
Practice Address - Phone:425-408-2536
Practice Address - Fax:425-939-1614
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000386772084P0800X
WAMD0000386772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1111087Medicaid
WAGAB16067Medicare PIN
WAH18986Medicare UPIN