Provider Demographics
NPI:1053577908
Name:CEARLOCK, MICHAEL BRAD (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRAD
Last Name:CEARLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:MI
Mailing Address - Zip Code:48884-9235
Mailing Address - Country:US
Mailing Address - Phone:989-291-3261
Mailing Address - Fax:
Practice Address - Street 1:301 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:MI
Practice Address - Zip Code:48884-9235
Practice Address - Country:US
Practice Address - Phone:989-291-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301097632207P00000X, 207Q00000X
WI101912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1538397120OtherGROUP NPI
MI27-0381199OtherTAX I D
MI1053577908Medicaid