Provider Demographics
NPI:1720205495
Name:SHERRY, CHARLES CHRISTOPHER (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CHRISTOPHER
Last Name:SHERRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:C.
Other - Middle Name:CHRISTOPHER
Other - Last Name:SHERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4100 LAKE DR SE
Practice Address - Street 2:SUITE 300
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8292
Practice Address - Country:US
Practice Address - Phone:616-267-8860
Practice Address - Fax:616-267-8442
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101076422207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON96810Medicare PIN