Provider Demographics
NPI:1053750356
Name:CHERRI, CATHERINE ROSE (MD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:ROSE
Last Name:CHERRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:CATHERINE
Other - Middle Name:ROSE
Other - Last Name:REILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19401 HUBBARD DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2641
Mailing Address - Country:US
Mailing Address - Phone:313-982-8100
Mailing Address - Fax:313-982-8072
Practice Address - Street 1:19401 HUBBARD DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2641
Practice Address - Country:US
Practice Address - Phone:313-982-8100
Practice Address - Fax:313-982-8072
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301103625207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine