Provider Demographics
NPI:1790781300
Name:SHERRARD, MARK D (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:SHERRARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1 SEAGATE # 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:734-240-8927
Mailing Address - Fax:734-240-4424
Practice Address - Street 1:718 N MACOMB ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-7815
Practice Address - Country:US
Practice Address - Phone:734-240-8927
Practice Address - Fax:734-240-4424
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101008675207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4332448Medicaid
MIE26419Medicare UPIN
MI0N35390002Medicare ID - Type Unspecified