Provider Demographics
NPI:1942375399
Name:ADRIAN SHEREMETA MD PC
Entity Type:Organization
Organization Name:ADRIAN SHEREMETA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEREMETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-779-1000
Mailing Address - Street 1:37675 PEMBROKE AVE
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1050
Mailing Address - Country:US
Mailing Address - Phone:734-779-1000
Mailing Address - Fax:734-779-1001
Practice Address - Street 1:37675 PEMBROKE AVE
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1050
Practice Address - Country:US
Practice Address - Phone:734-779-1000
Practice Address - Fax:734-779-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2019-07-03
Deactivation Date:2019-06-18
Deactivation Code:
Reactivation Date:2019-07-03
Provider Licenses
StateLicense IDTaxonomies
MIPM069773207R00000X
MIAS041942207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4620532Medicaid
MI110H223990OtherBCBSM GRP PIN
MI4245567Medicaid
MIH22174Medicare UPIN
MI4245567Medicaid
MIB48155Medicare UPIN