Provider Demographics
NPI:1376554188
Name:SAVAGE, CHERI KATHLEEN
Entity Type:Individual
Prefix:DR
First Name:CHERI
Middle Name:KATHLEEN
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W IRONWOOD DR
Mailing Address - Street 2:SUITE 155
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2656
Mailing Address - Country:US
Mailing Address - Phone:208-667-0585
Mailing Address - Fax:208-667-0876
Practice Address - Street 1:700 W IRONWOOD DR
Practice Address - Street 2:SUITE 155
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2656
Practice Address - Country:US
Practice Address - Phone:208-667-0585
Practice Address - Fax:208-667-0876
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM9272208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010150566OtherREGENCE BLUE SHIELD
ID000010150565OtherREGENCE BLUE SHIELD
WA8433591Medicaid
IDB4281OtherBLUE CROSS OF IDAHO
MT1376554188Medicaid
ID74260OtherBLUE CROSS OF IDAHO
ID807146700Medicaid
IDB4281OtherBLUE CROSS OF IDAHO
ID1131259Medicare ID - Type Unspecified