Provider Demographics
NPI:1568663763
Name:ADGEH, CHERINET SIRAW (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERINET
Middle Name:SIRAW
Last Name:ADGEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1202 LOUISIANA AVENUE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-3921
Mailing Address - Country:US
Mailing Address - Phone:318-212-8946
Mailing Address - Fax:318-212-4153
Practice Address - Street 1:2400 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 350
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2387
Practice Address - Country:US
Practice Address - Phone:318-212-8946
Practice Address - Fax:318-212-7995
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA202427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2101749Medicaid
LA4M986CP07Medicare PIN
LA4M986D391Medicare PIN