Individual
CHERYL HOPE HACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
30301 WOODWARD AVE, SUITE LL 165, ROYAL OAK, MI 48073-0979
(248) 435-9240
(248) 435-4765
Mailing address
25219 W ROYCOURT, HUNTINGTON WOODS, MI 48070-1741
(248) 542-0660
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
4301049051
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004387354
AETNA ID
—
01
—
1003675
WELLNESS
—
01
—
11277774
CAQH PROVIDER ID
—
01
—
2199
CAPE ID
—
01
—
3506336142
BCBS PIN NUMBER
MI
01
—
41049
OMNICARE ID
—
05
—
4171928
—
MI
Enumeration date
10/02/2006
Last updated
07/08/2007
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