Healthcare Provider Details

I. General information

NPI: 1124018536
Provider Name (Legal Business Name): SHEILA MARIE GENDICH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E LINCOLN AVE
IONIA MI
48846-1393
US

IV. Provider business mailing address

910 E LINCOLN AVE
IONIA MI
48846-1393
US

V. Phone/Fax

Practice location:
  • Phone: 616-527-2370
  • Fax: 616-527-3824
Mailing address:
  • Phone: 616-527-2370
  • Fax: 616-527-3824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301058189
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: