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:2024-04-24
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
174400000X
MIRC051733174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1607310061OtherBCN PIN
MI1607310061OtherBCBS PIN
MI562342902100OtherHEALTH PLUS ID
MI1275532954OtherMEDICARE BILLING PROVIDER
MI1275532954Medicaid
MI1275532954Medicaid
MI1275532954OtherMEDICARE BILLING PROVIDER