Provider Demographics
NPI:1386646396
Name:SHEREMETA, ADRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:
Last Name:SHEREMETA
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 1:37675 PEMBROKE AVE
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1050
Mailing Address - Country:US
Mailing Address - Phone:734-779-1000
Mailing Address - Fax:734-779-1001
Practice Address - Street 1:37675 PEMBROKE AVE
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1050
Practice Address - Country:US
Practice Address - Phone:734-779-1000
Practice Address - Fax:734-779-1001
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS041942207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110H223990OtherBCBS
MI4245567Medicaid
MIOP10850001Medicare PIN
MI110H223990OtherBCBS