Provider Demographics
NPI:1891960951
Name:RADHA CHERUKURI MD PC
Entity Type:Organization
Organization Name:RADHA CHERUKURI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RADHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERUKURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-755-4515
Mailing Address - Street 1:3785 BAY RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603
Mailing Address - Country:US
Mailing Address - Phone:989-791-2455
Mailing Address - Fax:989-791-1392
Practice Address - Street 1:800 COOPER AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5394
Practice Address - Country:US
Practice Address - Phone:989-755-4515
Practice Address - Fax:989-755-4516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRC051733174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1891960951OtherBCN
MI1891960951OtherBCBS
MI1891960951Medicaid
MI1891960951OtherHPLUS
MI1891960951OtherMEDICARE TYPE 2 BILLING NUMBER
MI1891960951OtherHPLUS