Provider Demographics
NPI:1376533471
Name:SHERMAN, GERALD J (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:J
Last Name:SHERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11080 HALL RD
Mailing Address - Street 2:STE A
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1511
Mailing Address - Country:US
Mailing Address - Phone:586-254-7200
Mailing Address - Fax:586-254-7201
Practice Address - Street 1:11080 HALL RD
Practice Address - Street 2:STE A
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1511
Practice Address - Country:US
Practice Address - Phone:586-254-7200
Practice Address - Fax:586-254-7201
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2009-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301025361207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101124737Medicaid
MI040E061920OtherBLUE SHIELD MICHIGAN
MI1124737Medicaid
B45764Medicare UPIN
0E063700 002Medicare ID - Type Unspecified
MI0E06192022Medicare PIN
MI1124737Medicaid