Healthcare Provider Details

I. General information

NPI: 1447250576
Provider Name (Legal Business Name): MADHAVI K. CHERUKURI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADHAVI KAMLAPURKER MD

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 05/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 RIDGE RD
MUNSTER IN
46321-1574
US

IV. Provider business mailing address

110 RIDGE RD
MUNSTER IN
46321-1574
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-0000
  • Fax: 219-836-2788
Mailing address:
  • Phone: 219-836-0000
  • Fax: 219-836-2788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01058204A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: