Provider Demographics
NPI:1235183039
Name:STERRETT, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:STERRETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:215 E MANSION ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068
Mailing Address - Country:US
Mailing Address - Phone:269-789-0015
Mailing Address - Fax:269-789-1551
Practice Address - Street 1:215 E MANSION ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068
Practice Address - Country:US
Practice Address - Phone:269-789-0015
Practice Address - Fax:269-789-1551
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIMS062609207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4229456Medicaid
MI4227792Medicaid
MI4227792Medicaid
F72487Medicare UPIN