Provider Demographics
NPI:1326158668
Name:CHERKASSKY, MICHAEL (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:CHERKASSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 W MAGNOLIA AVE
Mailing Address - Street 2:STE 207
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4637
Mailing Address - Country:US
Mailing Address - Phone:817-332-3089
Mailing Address - Fax:817-332-0574
Practice Address - Street 1:603 W MAGNOLIA AVE
Practice Address - Street 2:STE 207
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4637
Practice Address - Country:US
Practice Address - Phone:817-332-3089
Practice Address - Fax:817-338-0574
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9078174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN034198401Medicaid
TX00JG94Medicare ID - Type UnspecifiedMEDICARE
TXB21819Medicare UPIN