Provider Demographics
NPI:1043369523
Name:SPERRY, TRACEY M (DO)
Entity type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:M
Last Name:SPERRY
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:P.O. BOX 0446, LOBBY J
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-0446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:49650 CHERRY HILL ROAD
Practice Address - Street 2:SUITE 120
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187
Practice Address - Country:US
Practice Address - Phone:734-398-7800
Practice Address - Fax:734-398-7805
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2011-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101011328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF75527Medicare UPIN
MI0M95600003Medicare ID - Type Unspecified