Healthcare Provider Details

I. General information

NPI: 1952324436
Provider Name (Legal Business Name): ANTHONY THOMAS SHERIDAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12124 W LAKESHORE DR
BRIMLEY MI
49715-9319
US

IV. Provider business mailing address

12124 W LAKESHORE DR
BRIMLEY MI
49715-9319
US

V. Phone/Fax

Practice location:
  • Phone: 906-248-5527
  • Fax: 906-248-5765
Mailing address:
  • Phone: 906-248-5527
  • Fax: 906-248-5765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301060379
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: