Provider Demographics
NPI:1124018536
Name:GENDICH, SHEILA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:MARIE
Last Name:GENDICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-1393
Mailing Address - Country:US
Mailing Address - Phone:616-527-2370
Mailing Address - Fax:616-527-3824
Practice Address - Street 1:910 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-1393
Practice Address - Country:US
Practice Address - Phone:616-527-2370
Practice Address - Fax:616-527-3824
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058189207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0801900322OtherBC
608524300OtherUS DEPT OF LABOR
MI0N43320Medicare PIN
608524300OtherUS DEPT OF LABOR