Provider Demographics
NPI:1326091406
Name:EWING, SHERI L (DO)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:L
Last Name:EWING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E H ST
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-4760
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:629 W CLOVERLAND DR STE 1
Practice Address - Street 2:
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938
Practice Address - Country:US
Practice Address - Phone:906-932-0032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI125100OtherMERCY CARE CHOICES
MI3518655OtherCIGNA
MICC3713OtherRR MEDICARE
MI3312979Medicaid
MI1596902OtherUNITED HEALTH CARE
MI5101011849OtherPHYSICIAN LICENSE
MI5609677OtherAETNA
MI700H21076OtherBCBSM
MIC3743OtherMCARE
MI700H21076OtherBCBSM