| D/b/a Cherry Valley Medical Clinic | |
|
1848 Daimler Rd Rockford IL 61112-1019 | |
| (815) 229-2500 | |
| (815) 398-9587 |
| Full Name | D/b/a Cherry Valley Medical Clinic |
|---|---|
| Speciality | General Practice |
| Location | 1848 Daimler Rd, Rockford, Illinois |
| Authorized Official Name and Position | Thomas L Michalsen (PRESIDENT) |
| Authorized Official Contact | 8152292500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| D/b/a Cherry Valley Medical Clinic 1848 Daimler Rd Rockford IL 61112-1019 Ph: (815) 229-2500 | D/b/a Cherry Valley Medical Clinic 1848 Daimler Rd Rockford IL 61112-1019 Ph: (815) 229-2500 |
| NPI Number | 1013930353 |
|---|---|
| Provider Enumeration Date | 07/26/2006 |
| Last Update Date | 08/13/2008 |
| Medicare PECOS PAC ID | 0749280451 |
|---|---|
| Medicare Enrollment ID | O20080717000221 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013930353 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Thomas Michalsen |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1114947876 PECOS PAC ID: 9739156043 Enrollment ID: I20080718000036 |
| Provider Name | Cathy L Carlson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225431653 PECOS PAC ID: 4880983378 Enrollment ID: I20221013003459 |
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