Provider Demographics
NPI:1679918130
Name:MCCORMICK, SEAN TESHIMA (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:TESHIMA
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4286 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-6130
Mailing Address - Country:US
Mailing Address - Phone:510-499-0726
Mailing Address - Fax:
Practice Address - Street 1:4201 SAINT ANTOINE ST
Practice Address - Street 2:#9C/UHC
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-5147
Practice Address - Fax:313-966-0880
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2015-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301103309207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine