Provider Demographics
NPI:1134149164
Name:RAY, CHERYL (DO)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:RAY
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 1:2711 ALLEN BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-2287
Mailing Address - Country:US
Mailing Address - Phone:608-930-8000
Mailing Address - Fax:608-826-2710
Practice Address - Street 1:2711 ALLEN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-2287
Practice Address - Country:US
Practice Address - Phone:608-930-8000
Practice Address - Fax:608-826-2710
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI342672084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30059300Medicaid
E49392Medicare UPIN
WI30059300Medicaid