Healthcare Provider Details

I. General information

NPI: 1295350718
Provider Name (Legal Business Name): JACOB SHERMETARO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 S 11TH ST
KALAMAZOO MI
49009-2175
US

IV. Provider business mailing address

2490 S 11TH ST STE 201
KALAMAZOO MI
49009-2175
US

V. Phone/Fax

Practice location:
  • Phone: 269-343-1535
  • Fax:
Mailing address:
  • Phone: 269-343-1535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5151014547
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number335727
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number5101029452
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: