Provider Demographics
NPI:1437554144
Name:SHERIFF, MOMODU (MD)
Entity Type:Individual
Prefix:
First Name:MOMODU
Middle Name:
Last Name:SHERIFF
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 1:42633 GARFIELD RD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5033
Mailing Address - Country:US
Mailing Address - Phone:888-819-4677
Mailing Address - Fax:
Practice Address - Street 1:2646 HIGHWAY AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-1661
Practice Address - Country:US
Practice Address - Phone:219-595-0604
Practice Address - Fax:219-513-8678
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11009906A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine