Provider Demographics
NPI:1679526792
Name:TAMBURELLO, CHERYL (MD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:TAMBURELLO
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 1:245 STATE ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4328
Mailing Address - Country:US
Mailing Address - Phone:616-685-1808
Mailing Address - Fax:616-685-1850
Practice Address - Street 1:245 STATE ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4328
Practice Address - Country:US
Practice Address - Phone:616-685-1808
Practice Address - Fax:616-685-1850
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3403910Medicaid
MI4278030Medicaid
MI4181675Medicaid
MI4278076Medicaid
MI4269765Medicaid
MI4878892Medicaid
MI4878927Medicaid
MI2994892Medicaid
MI4278049Medicaid
MI4278085Medicaid
MI4748163Medicaid
MI4878936Medicaid
MI3415887Medicaid
MI3436116Medicaid
MI4517086Medicaid
MI4878945Medicaid
MI4269765Medicaid
MI4878892Medicaid
MI4878927Medicaid
MI3415887Medicaid