Healthcare Provider Details

I. General information

NPI: 1720151608
Provider Name (Legal Business Name): CHERIE YVONNE ZACHARY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 WOODWINDS DRIVE SUITE #240
WOODBURY MN
55125
US

IV. Provider business mailing address

2080 WOODWINDS DRIVE SUITE #240
WOODBURY MN
55125
US

V. Phone/Fax

Practice location:
  • Phone: 651-702-0750
  • Fax: 651-645-6166
Mailing address:
  • Phone: 651-702-0750
  • Fax: 651-645-6166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number40849
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: