Healthcare Provider Details

I. General information

NPI: 1871931469
Provider Name (Legal Business Name): TIFFANI MICHELLE CHERRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2724 NASHVILLE RD
BOWLING GREEN KY
42101-4000
US

IV. Provider business mailing address

201 PARK ST
BOWLING GREEN KY
42101-1759
US

V. Phone/Fax

Practice location:
  • Phone: 270-781-5111
  • Fax: 270-936-6025
Mailing address:
  • Phone: 270-781-5111
  • Fax: 270-936-6025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125063028
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTP270
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: