Provider Demographics
NPI:1477510188
Name:SHERWOOD MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:SHERWOOD MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONRAD
Authorized Official - Middle Name:CUTHBERT
Authorized Official - Last Name:MAITLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-864-4452
Mailing Address - Street 1:7441 W 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2123
Mailing Address - Country:US
Mailing Address - Phone:313-864-4452
Mailing Address - Fax:313-864-4469
Practice Address - Street 1:7441 W 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2123
Practice Address - Country:US
Practice Address - Phone:313-864-4452
Practice Address - Fax:313-864-4469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI046953208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB45947Medicare UPIN