Provider Demographics
NPI:1790846517
Name:SHORT, CHERYL D (MD, FACOG)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:D
Last Name:SHORT
Suffix:
Gender:F
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:85 EAST US HIGHWAY 6
Mailing Address - Street 2:SUITE 330
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383
Mailing Address - Country:US
Mailing Address - Phone:219-462-6144
Mailing Address - Fax:219-465-1150
Practice Address - Street 1:85 EAST US HIGHWAY 6
Practice Address - Street 2:SUITE 330
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383
Practice Address - Country:US
Practice Address - Phone:219-462-6144
Practice Address - Fax:219-465-1150
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01043927207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200042030AMedicaid
ING13081Medicare UPIN
IN651320EMedicare PIN