Provider Demographics
NPI:1548458177
Name:VIOLA, SHERRY L (MD)
Entity type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:L
Last Name:VIOLA
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 1:1777 AXTELL DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4404
Mailing Address - Country:US
Mailing Address - Phone:248-649-0450
Mailing Address - Fax:248-649-1238
Practice Address - Street 1:1777 AXTELL DR
Practice Address - Street 2:SUITE 107
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4404
Practice Address - Country:US
Practice Address - Phone:248-649-0450
Practice Address - Fax:248-649-1238
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISV403956174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3244233Medicaid
MI0M22290Medicare PIN
MI3244233Medicaid