Provider Demographics
NPI:1629185483
Name:CHERMAK, CALLY (MD)
Entity Type:Individual
Prefix:DR
First Name:CALLY
Middle Name:
Last Name:CHERMAK
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 1:3316 W 66TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2506
Mailing Address - Country:US
Mailing Address - Phone:952-920-3808
Mailing Address - Fax:952-920-8899
Practice Address - Street 1:3316 W 66TH ST
Practice Address - Street 2:STE 200
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2506
Practice Address - Country:US
Practice Address - Phone:952-920-3808
Practice Address - Fax:952-920-8899
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN44305207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH23387Medicare UPIN