Provider Demographics
NPI:1043491343
Name:MICHAEL S. SHERMAN, DO, PC
Entity Type:Organization
Organization Name:MICHAEL S. SHERMAN, DO, PC
Other - Org Name:PHYSICAN EYE CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-421-0790
Mailing Address - Street 1:6255 INKSTER RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2577
Mailing Address - Country:US
Mailing Address - Phone:734-421-0790
Mailing Address - Fax:734-421-3780
Practice Address - Street 1:6255 INKSTER RD
Practice Address - Street 2:SUITE 303
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2577
Practice Address - Country:US
Practice Address - Phone:734-421-0790
Practice Address - Fax:734-421-3780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010605207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3355555-11Medicaid
OM36150Medicare PIN
MI3355555-11Medicaid