Provider Demographics
NPI:1255519526
Name:MICHAEL SHERBIN DO PC
Entity type:Organization
Organization Name:MICHAEL SHERBIN DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-463-5831
Mailing Address - Street 1:309 NORTHBOUND GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:MT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-5748
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:309 NORTHBOUND GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:MT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-5748
Practice Address - Country:US
Practice Address - Phone:586-463-5831
Practice Address - Fax:586-463-4742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMS005786207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0485003484OtherBCBS OF MICHIGAN
MI111208372Medicaid
MI0455026324OtherBCBS OF MICHIGAN
MI111258178Medicaid
MI0485003484OtherBCBS OF MICHIGAN
MIE26413Medicare UPIN
MI8500348Medicare PIN