=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679592968
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL G. SHERICK M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2006
-----------------------------------------------------
Last Update Date | 06/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5333 MCAULEY DR SUITE R5001
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48197-1014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-712-2323
-----------------------------------------------------
Fax | 734-712-2312
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5333 MCAULEY DR SUITE R5001
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48197-1014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-712-2323
-----------------------------------------------------
Fax | 734-712-2312
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | 4301058063
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------