Provider Demographics
NPI:1982638086
Name:SHERROD, SHIRLEY T (MD)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:T
Last Name:SHERROD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 W OUTER DR
Mailing Address - Street 2:STE 321
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235
Mailing Address - Country:US
Mailing Address - Phone:313-341-5100
Mailing Address - Fax:313-861-9200
Practice Address - Street 1:6001 W OUTER DR
Practice Address - Street 2:STE 321
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235
Practice Address - Country:US
Practice Address - Phone:313-341-5100
Practice Address - Fax:313-861-9200
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033837207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1213150005OtherWELLNESS PLAN PIN
MIB43583OtherHEALTH ALLIANCE PLAN PIN
MI5536239OtherAETNA PIN
MI1808205381OtherBCBS PIN
MI48818OtherOMNICARE COVENTRY PIN
MI122752OtherGREAT LAKES HEALTH PIN
MI82025201OtherPROCARE HEALTH PLAN PIN
MI0820538OtherBCBS
MI1213150005OtherWELLNESS PLAN PIN
MI1808205381OtherBCBS PIN
MI122752OtherGREAT LAKES HEALTH PIN