Provider Demographics
NPI:1891788691
Name:BRODY, CHERYL L (DO)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:L
Last Name:BRODY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17850 KEDZIE AVE STE 3250
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2082
Mailing Address - Country:US
Mailing Address - Phone:708-799-8700
Mailing Address - Fax:708-957-1830
Practice Address - Street 1:17850 KEDZIE AVE STE 3250
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2082
Practice Address - Country:US
Practice Address - Phone:708-799-8700
Practice Address - Fax:708-957-1830
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-090559207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL060053885OtherPALMETTO GBA INDIVIDUAL #
IL21622931OtherBCBS GROUP #
IL036090559Medicaid
ILCI8250OtherPALMETTO GBA GROUP #
IL526200Medicare ID - Type UnspecifiedMEDICARE GROUP #