Provider Demographics
NPI:1912920620
Name:OH, CHERYL ICHAW (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ICHAW
Last Name:OH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 W PINEVIEW ST
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2007
Mailing Address - Country:US
Mailing Address - Phone:407-862-3400
Mailing Address - Fax:407-862-6277
Practice Address - Street 1:125 W PINEVIEW ST
Practice Address - Street 2:SUITE 1001
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2007
Practice Address - Country:US
Practice Address - Phone:407-862-3400
Practice Address - Fax:407-862-6277
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME64928207QS1201X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080101577OtherRAILROAD MEDICARE
FL26849OtherBCBS
FL377400701Medicaid
FL26849OtherBCBS
G01843Medicare UPIN