Provider Demographics
NPI:1518962026
Name:SCHERMERHORN, THOMAS CARLL (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CARLL
Last Name:SCHERMERHORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:T.C.
Other - Middle Name:
Other - Last Name:SCHERMERHORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1221 SIXTH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2360
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1221 SIXTH ST STE 300
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-392-0640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083353207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI130B813210OtherBCBS GROUP
MI4625744 TYPE 10Medicaid
MI1402810380OtherBCBS OF MICHIGAN
MIP00344571OtherRAILROAD MEDICARE
MI0N97080Medicare ID - Type Unspecified
MI4625744 TYPE 10Medicaid
MI1402810380OtherBCBS OF MICHIGAN