MEDICARE: CHEROKEE MCDUFFEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372600000X	Adult Companion

General Provider Information

NPI Number	:	1053035972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHEROKEE MCDUFFEY

Provider Business Mailing Address
First Line	:	4248 N LOCKWOOD AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43612-1762
Country	:	US
Telephone Number	:	419-283-6128
Fax Number	:

Provider Business Practice Location Address
First Line	:	4248 N LOCKWOOD AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43612-1762
Country	:	US
Telephone Number	:	419-283-6128
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	10/04/2022

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Directions to “ CHEROKEE MCDUFFEY ” Practice Location

Language	Start Address	Practice Location

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