Provider Demographics
NPI:1255723946
Name:SHERWOOD, NATHANIEL CHRISTIAN
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:CHRISTIAN
Last Name:SHERWOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13210 E JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-2704
Mailing Address - Country:US
Mailing Address - Phone:313-335-3444
Mailing Address - Fax:313-484-4998
Practice Address - Street 1:13210 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2704
Practice Address - Country:US
Practice Address - Phone:313-335-3444
Practice Address - Fax:313-484-4998
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102204620207R00000X
MI5101026466207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty