Provider Demographics
NPI:1205843752
Name:DWYER, CHERYL (DO)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:DWYER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 CAMPUS RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640
Mailing Address - Country:US
Mailing Address - Phone:989-839-3170
Mailing Address - Fax:989-839-1840
Practice Address - Street 1:4320 CAMPUS RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640
Practice Address - Country:US
Practice Address - Phone:989-839-3170
Practice Address - Fax:989-839-1840
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICD007896207VX0000X
MI5101007896207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM41050003Medicare PIN
MIA76250Medicare UPIN