Provider Demographics
NPI:1639147473
Name:CHERUKURI, LAVANYA A (MD)
Entity Type:Individual
Prefix:DR
First Name:LAVANYA
Middle Name:A
Last Name:CHERUKURI
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 1:2 HURLEY PLZ STE 204
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-5905
Mailing Address - Country:US
Mailing Address - Phone:810-606-0999
Mailing Address - Fax:
Practice Address - Street 1:2 HURLEY PLZ
Practice Address - Street 2:SUITE 204
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5903
Practice Address - Country:US
Practice Address - Phone:810-239-9444
Practice Address - Fax:810-239-8729
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075909207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MII11605Medicare UPIN