Healthcare Provider Details

I. General information

NPI: 1053307819
Provider Name (Legal Business Name): SHERI GLADISH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CONOVER DR
FRANKLIN OH
45005-1900
US

IV. Provider business mailing address

333 CONOVER DR
FRANKLIN OH
45005-1900
US

V. Phone/Fax

Practice location:
  • Phone: 937-746-8795
  • Fax: 937-746-7062
Mailing address:
  • Phone: 937-746-8795
  • Fax: 937-746-7062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35-073062
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number063422
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: