Individual
CHERYL LYNN CODY DEETS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
16585 LAKE RIDGE DR, MAPLE GROVE, MN 55311-1455
(763) 710-0353
Mailing address
16585 LAKE RIDGE DR, MAPLE GROVE, MN 55311-1455
(763) 710-0353
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
38905
WI
207V00000X
Obstetrics & Gynecology Physician
Primary
58004
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32353300
—
WI
05
—
BD4497764658
—
MN
01
—
H400175037
MEDICARE
MN
Enumeration date
08/30/2006
Last updated
12/30/2024
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