Provider Demographics
NPI:1376553586
Name:LOUBERT, CHERYL S (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:S
Last Name:LOUBERT
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 1:609 QUARTER ST
Mailing Address - Street 2:
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-1941
Mailing Address - Country:US
Mailing Address - Phone:989-246-6471
Mailing Address - Fax:989-246-6486
Practice Address - Street 1:609 QUARTER ST
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-1941
Practice Address - Country:US
Practice Address - Phone:989-246-6471
Practice Address - Fax:989-246-6486
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICL069006207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG52395Medicare UPIN