Provider Demographics
NPI:1073662250
Name:SHERRY L. VIOLA MD PC
Entity Type:Organization
Organization Name:SHERRY L. VIOLA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:VIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-649-0450
Mailing Address - Street 1:1777 AXTELL DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4404
Mailing Address - Country:US
Mailing Address - Phone:248-649-0450
Mailing Address - Fax:248-649-1238
Practice Address - Street 1:1777 AXTELL DR
Practice Address - Street 2:SUITE 107
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4404
Practice Address - Country:US
Practice Address - Phone:248-649-0450
Practice Address - Fax:248-649-1238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301403956174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3244233Medicaid
MI3244233Medicaid
MIA78879Medicare UPIN