Healthcare Provider Details

I. General information

NPI: 1275532954
Provider Name (Legal Business Name): RADHA CHERUKURI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date: 03/18/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

1000 HOUGHTON AVE
SAGINAW MI
48602-5303
US

IV. Provider business mailing address

1000 HOUGHTON AVE
SAGINAW MI
48602-5303
US

V. Phone/Fax

Practice location:
  • Phone: 989-746-7500
  • Fax: 989-746-7723
Mailing address:
  • Phone: 989-746-7500
  • Fax: 989-746-7723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberRC051733
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number4301051733
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: