Healthcare Provider Details

I. General information

NPI: 1063403335
Provider Name (Legal Business Name): MICHAEL SHERMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6255 INKSTER RD STE 303
GARDEN CITY MI
48135
US

IV. Provider business mailing address

6255 INKSTER RD STE 303
GARDEN CITY MI
48135
US

V. Phone/Fax

Practice location:
  • Phone: 734-421-0790
  • Fax: 734-421-3780
Mailing address:
  • Phone: 734-421-0790
  • Fax: 734-421-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number5101010605
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: