Provider Demographics
NPI:1669462693
Name:PARKS, SHERYL LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:LYNN
Last Name:PARKS
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 1:500 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1452
Mailing Address - Country:US
Mailing Address - Phone:906-483-1050
Mailing Address - Fax:906-372-3230
Practice Address - Street 1:500 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1452
Practice Address - Country:US
Practice Address - Phone:906-483-1050
Practice Address - Fax:906-372-3230
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042687207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4130980Medicaid
B48900Medicare UPIN
MIMI8082006Medicare PIN