Basic Information
| Provider Information | |||||||||
| NPI: | 1396970950 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | CHERIAN | ||||||||
| FirstName: | CECIL | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10051 5TH STREET NORTH ATTN: CREDENTIALING | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278240780 | ||||||||
| FaxNumber: | 8136348210 | ||||||||
| Practice Location | |||||||||
| Address1: | 781 CYPRESS VILLAGE BLVD | ||||||||
| Address2: | |||||||||
| City: | RUSKIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335736801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136333600 | ||||||||
| FaxNumber: | 8136348210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2009 | ||||||||
| LastUpdateDate: | 12/15/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 27027 | OK | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME113498 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 006501200 | 05 | FL | MEDICAID |