Healthcare Provider Details

I. General information

NPI: 1205920873
Provider Name (Legal Business Name): MICHAEL SHERBIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 NORTHBOUND GRATIOT AVE
MOUNT CLEMENS MI
48043-5748
US

IV. Provider business mailing address

309 NORTHBOUND GRATIOT AVE
MOUNT CLEMENS MI
48043-5748
US

V. Phone/Fax

Practice location:
  • Phone: 586-463-5831
  • Fax: 586-463-4742
Mailing address:
  • Phone: 586-463-5831
  • Fax: 586-463-4742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number5101005786
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number5101005786
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number5101005786
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: