Provider Demographics
NPI:1346335197
Name:ARVANITIS, CHERYL R (DO)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:R
Last Name:ARVANITIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:RAILING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:253 SAGAMORE PKWY W
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1501
Practice Address - Country:US
Practice Address - Phone:765-448-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-007848R207Q00000X
KY02966207Q00000X
WV2173207Q00000X
IN02004509A207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201262500Medicaid
IN000000905552OtherANTHEM PROVIDER NUMBER
OH2363204Medicaid
OH2363204Medicaid
INP01422302Medicare PIN
KY0264277Medicare PIN
H35348Medicare UPIN
OH4091525Medicare PIN
OH409524Medicare PIN
KY0632968Medicare PIN
IN201262500Medicaid
OH4091523Medicare PIN
BR6946113OtherDEA
KY0307672Medicare PIN
IN000000905552OtherANTHEM PROVIDER NUMBER
KYP00379178Medicare PIN
KY3403626Medicare PIN
IN815500083Medicare PIN