Provider Demographics
NPI:1467493197
Name:CERNAK, CYNTHIA RAE (DPM)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:RAE
Last Name:CERNAK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805B SPRING ST STE 130
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1642
Mailing Address - Country:US
Mailing Address - Phone:262-631-8750
Mailing Address - Fax:262-631-8754
Practice Address - Street 1:3805B SPRING ST STE 130
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53405-1642
Practice Address - Country:US
Practice Address - Phone:262-631-8750
Practice Address - Fax:262-631-8754
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004331213E00000X
WI614-025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004331Medicaid
WI43206800Medicaid
WIT95283Medicare UPIN
ILF400183317Medicare PIN