Basic Information
| Provider Information | |||||||||
| NPI: | 1952314049 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHERAYIL | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 15TH AVE | ||||||||
| Address2: | #180 | ||||||||
| City: | SOUTH MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531721160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147685430 | ||||||||
| FaxNumber: | 4147624225 | ||||||||
| Practice Location | |||||||||
| Address1: | 902 MILWAUKEE AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531722118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147644003 | ||||||||
| FaxNumber: | 4147644005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 11/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 36905-20 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 36905 | WI | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.