Basic Information
| Provider Information | |||||||||
| NPI: | 1972822773 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHERMAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | RICHARD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4340 CLYO RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454597000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373962602 | ||||||||
| FaxNumber: | 9373953682 | ||||||||
| Practice Location | |||||||||
| Address1: | WRIGHT PATTERSON MEDICAL CENTER | ||||||||
| Address2: | 4881 SUGAR MAPLE DR | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372570837 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2010 | ||||||||
| LastUpdateDate: | 12/09/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 35.134295 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 0318714 | 05 | OH | MEDICAID |