Provider Demographics
NPI:1417974197
Name:SIERZPUTOWSKI, SHARON (PAC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:SIERZPUTOWSKI
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 HAGER DR
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8774
Mailing Address - Country:US
Mailing Address - Phone:231-242-1700
Mailing Address - Fax:231-242-1717
Practice Address - Street 1:1080 HAGER DR
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8774
Practice Address - Country:US
Practice Address - Phone:231-242-1700
Practice Address - Fax:231-242-1717
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003567363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
H36079Medicare UPIN
0N46770Medicare ID - Type Unspecified