Provider Demographics
NPI:1487284873
Name:SHERMAN II, ROGER II
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:
Last Name:SHERMAN II
Suffix:II
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 1:1841 N PERRY ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-2235
Mailing Address - Country:US
Mailing Address - Phone:248-409-4130
Mailing Address - Fax:
Practice Address - Street 1:1841 N PERRY ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-2235
Practice Address - Country:US
Practice Address - Phone:248-409-4130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS655744007947Medicaid