Provider Demographics
NPI:1265692123
Name:GAMBREL, CHERIE O (MD)
Entity type:Individual
Prefix:DR
First Name:CHERIE
Middle Name:O
Last Name:GAMBREL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHERIE
Other - Middle Name:O
Other - Last Name:SIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-1325
Mailing Address - Country:US
Mailing Address - Phone:606-526-8131
Mailing Address - Fax:606-528-8661
Practice Address - Street 1:14949 N US HIGHWAY 25 E
Practice Address - Street 2:STE. 4
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-6285
Practice Address - Country:US
Practice Address - Phone:606-528-0305
Practice Address - Fax:606-523-4368
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036128438207Q00000X
IL125055005390200000X
KY48556207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01246907OtherRR MEDICARE
KY7100385270Medicaid
KYK194980Medicare PIN
208905647Medicare PIN