Provider Demographics
NPI:1952314049
Name:CHERAYIL, GEORGE D (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:D
Last Name:CHERAYIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 15TH AVE
Mailing Address - Street 2:#180
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-1160
Mailing Address - Country:US
Mailing Address - Phone:414-768-5430
Mailing Address - Fax:414-762-4225
Practice Address - Street 1:902 MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-2118
Practice Address - Country:US
Practice Address - Phone:414-764-4003
Practice Address - Fax:414-764-4005
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36905-20207Q00000X
WI36905208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI02120-0316Medicare PIN
WI68015-0116Medicare PIN