Healthcare Provider Details

I. General information

NPI: 1184839011
Provider Name (Legal Business Name): SHERRY KUO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LAFAYETTE SE STE 3200
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

245 STATE ST SE STE 221
GRAND RAPIDS MI
49503
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-6920
  • Fax: 616-685-5110
Mailing address:
  • Phone: 616-685-1808
  • Fax: 616-685-1850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101015997
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number5101015977
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: