Healthcare Provider Details

I. General information

NPI: 1336124692
Provider Name (Legal Business Name): SETH BRIAN SHERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5995 OPUS PKWY SUITE 200
MINNETONKA MN
55343-8387
US

IV. Provider business mailing address

1522 WEBSTER RD
DANVILLE KY
40422-9760
US

V. Phone/Fax

Practice location:
  • Phone: 952-392-1100
  • Fax:
Mailing address:
  • Phone: 859-236-8231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number28255
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: