Provider Demographics
NPI:1447250774
Name:DILLER, CHERI JAN (MD)
Entity type:Individual
Prefix:
First Name:CHERI
Middle Name:JAN
Last Name:DILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 HARMON RD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:OH
Mailing Address - Zip Code:45817-1069
Mailing Address - Country:US
Mailing Address - Phone:419-369-4804
Mailing Address - Fax:419-369-4805
Practice Address - Street 1:582 HARMON RD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:OH
Practice Address - Zip Code:45817-1069
Practice Address - Country:US
Practice Address - Phone:419-369-4804
Practice Address - Fax:419-369-4805
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048316D207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0549713Medicaid
OH1447250774OtherMEDICAL MUTUAL
OHC02676Medicare UPIN