Provider Demographics
NPI:1871579441
Name:HESS, CHERYL L (MD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:HESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1234 E. DUPONT RD.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1545
Mailing Address - Country:US
Mailing Address - Phone:260-373-9728
Mailing Address - Fax:260-373-4585
Practice Address - Street 1:2710 LAKE AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5412
Practice Address - Country:US
Practice Address - Phone:260-373-8070
Practice Address - Fax:260-373-8071
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01052835A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000181521OtherANTHEM
IN200292470Medicaid
00002078073 06OtherUNITED HEALTHCARE
IN3937240024OtherMEDICARE DMEPOS
7551153OtherAETNA
IN10916OtherPHYSICIANS HEALTH PLAN
IN080160016OtherRAILROAD MEDICARE
IN10916OtherPHYSICIANS HEALTH PLAN
IN080160016OtherRAILROAD MEDICARE