1215962345 NPI number — SHIRLEY T SHERROD MD PC

Table of content: (NPI 1215962345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215962345 NPI number — SHIRLEY T SHERROD MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHIRLEY T SHERROD MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215962345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22200 W 11 MILE RD
Provider Second Line Business Mailing Address:
BOX NO. 515
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48037-7136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-320-7200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22200 W 11 MILE RD
Provider Second Line Business Practice Location Address:
BOX NO. 515
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48037-7136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-320-7200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHERROD
Authorized Official First Name:
SHIRLEY
Authorized Official Middle Name:
T
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
313-320-7200

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  4301033837 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1097952 10 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 48818 . This is a "OMNICARE COVENTRY PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: B43583 . This is a "HEALTH ALLIANCE PLAN PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1213150005 . This is a "WELLNESS PLAN PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 122752 . This is a "GREAT LAKES HEALTH PLAN PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1808205381 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5536239 . This is a "AETNA PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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