Provider Demographics
NPI:1831117613
Name:SPRIK, SHERMAN ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:SHERMAN
Middle Name:ALLEN
Last Name:SPRIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 KENMOOR AVE SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8622
Mailing Address - Country:US
Mailing Address - Phone:616-575-1212
Mailing Address - Fax:616-575-1219
Practice Address - Street 1:655 KENMOOR AVE SE
Practice Address - Street 2:SUITE A
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8622
Practice Address - Country:US
Practice Address - Phone:616-575-1212
Practice Address - Fax:616-575-1219
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISS046182207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D11035OtherBLUE CROSS BLUE SHIELD
MI3205253Medicaid
MI40009453OtherRAILROAD MEDICARE
MIOM18820Medicare ID - Type Unspecified
MI3205253Medicaid
MI40009453OtherRAILROAD MEDICARE