Provider Demographics
NPI:1861457772
Name:SCHERVISH, EDWARD W (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:W
Last Name:SCHERVISH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:20952 E 12 MILE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3200
Mailing Address - Country:US
Mailing Address - Phone:586-771-4820
Mailing Address - Fax:586-771-6620
Practice Address - Street 1:20952 E 12 MILE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3200
Practice Address - Country:US
Practice Address - Phone:586-771-4820
Practice Address - Fax:586-771-6620
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2008-07-28
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Provider Licenses
StateLicense IDTaxonomies
MI4301405285208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF02013OtherHAP
MI01004491OtherHEALTH PLUS
MI103356OtherPRIORITY HEALTH
MI340006535OtherRAILROAD MEDICARE
MI5135046OtherAETNA
MI2366014003OtherCIGNA
MI2366014003OtherCIGNA
MI0E06273006Medicare PIN
MI01004491OtherHEALTH PLUS