Provider Demographics
NPI:1003074089
Name:GRETTA SHARA, DPM, PC
Entity Type:Organization
Organization Name:GRETTA SHARA, DPM, PC
Other - Org Name:ARMADA FOOT AND ANKLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-784-0184
Mailing Address - Street 1:PO BOX 907
Mailing Address - Street 2:
Mailing Address - City:ARMADA
Mailing Address - State:MI
Mailing Address - Zip Code:48005-0907
Mailing Address - Country:US
Mailing Address - Phone:586-784-0184
Mailing Address - Fax:586-784-5227
Practice Address - Street 1:23064 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ARMADA
Practice Address - State:MI
Practice Address - Zip Code:48005-4705
Practice Address - Country:US
Practice Address - Phone:586-784-0184
Practice Address - Fax:586-784-5227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001789213E00000X, 332B00000X
MI261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540E001930OtherBCBSDME
MI480E027910OtherBCBS GROUP PIN
MI540E001930OtherBCBSDME
MI5762300001Medicare NSC
MIU65279Medicare UPIN