Provider Demographics
NPI:1588658116
Name:CHERUKURI, RADHIKA C (MD)
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:C
Last Name:CHERUKURI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1709 KY ROUTE 321
Mailing Address - Street 2:STE 3 BIG SANDY HEALTH CARE INC
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-9101
Mailing Address - Country:US
Mailing Address - Phone:606-886-8546
Mailing Address - Fax:606-886-8548
Practice Address - Street 1:178 DOUGLAS PKWY
Practice Address - Street 2:SHELBY VALLEY CLINIC
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-6970
Practice Address - Country:US
Practice Address - Phone:606-639-3135
Practice Address - Fax:606-639-3136
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
KY37725207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6406347200Medicaid
KY6406347200Medicaid
KY0396124Medicare ID - Type Unspecified