Provider Demographics
NPI:1437373586
Name:SHERMAN, TRACY L (MD)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:L
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:TWO RIVERS
Mailing Address - State:WI
Mailing Address - Zip Code:54241-2416
Mailing Address - Country:US
Mailing Address - Phone:920-793-2281
Mailing Address - Fax:920-794-7553
Practice Address - Street 1:2219 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:TWO RIVERS
Practice Address - State:WI
Practice Address - Zip Code:54241-2416
Practice Address - Country:US
Practice Address - Phone:920-793-2281
Practice Address - Fax:920-794-7553
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37871-020207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32241400Medicaid
WI32241400Medicaid
WIG32675Medicare UPIN
WV000160006Medicare ID - Type UnspecifiedFAMILY PRACTICE PHYSICIAN