Healthcare Provider Details

I. General information

NPI: 1417004219
Provider Name (Legal Business Name): JASMINE A. CHERIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 S 11TH ST
NILES MI
49120-4074
US

IV. Provider business mailing address

2002 S 11TH ST
NILES MI
49120-4074
US

V. Phone/Fax

Practice location:
  • Phone: 269-687-0200
  • Fax:
Mailing address:
  • Phone: 269-687-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301044588
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number80138
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: