Provider Demographics
NPI:1871908087
Name:CHUNG, CHERIE (MD)
Entity type:Individual
Prefix:
First Name:CHERIE
Middle Name:
Last Name:CHUNG
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 1:3990 JOHN R STREET
Mailing Address - Street 2:BOX 160, ROOM 2901
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-745-7233
Mailing Address - Fax:313-993-3889
Practice Address - Street 1:3990 JOHN R STREET
Practice Address - Street 2:BOX 160, ROOM 2901
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-7233
Practice Address - Fax:313-993-3889
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.136791207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program