Provider Demographics
NPI:1114051935
Name:DANIEL D SHERBERT MD
Entity Type:Organization
Organization Name:DANIEL D SHERBERT MD
Other - Org Name:WEST MAPLE PLASTIC SURGERY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHERBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-865-6400
Mailing Address - Street 1:5807 W MAPLE RD
Mailing Address - Street 2:SUITE 177
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4483
Mailing Address - Country:US
Mailing Address - Phone:248-865-6400
Mailing Address - Fax:248-865-6404
Practice Address - Street 1:5807 W MAPLE RD
Practice Address - Street 2:SUITE 177
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4483
Practice Address - Country:US
Practice Address - Phone:248-865-6400
Practice Address - Fax:248-865-6404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2009-07-23
Deactivation Date:2008-08-04
Deactivation Code:
Reactivation Date:2009-06-25
Provider Licenses
StateLicense IDTaxonomies
MI4301051281208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI346090810Medicaid
MI240F376480OtherBCBSM
MI240F376480OtherBCBSM
MI346090810Medicaid
MIG06555Medicare UPIN