Provider Demographics
NPI:1548362015
Name:CHILD, CHERYL E (DO)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:E
Last Name:CHILD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 56TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-2012
Mailing Address - Country:US
Mailing Address - Phone:515-279-2298
Mailing Address - Fax:
Practice Address - Street 1:1922 INGERSOLL AVE STE 102
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3332
Practice Address - Country:US
Practice Address - Phone:515-282-5066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2150170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAD46551Medicare UPIN