Provider Demographics
NPI:1003808809
Name:DANESH, SHARAM (MD)
Entity Type:Individual
Prefix:MR
First Name:SHARAM
Middle Name:
Last Name:DANESH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HOSSEIN
Other - Middle Name:
Other - Last Name:DANESHUAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4045 E UNION HILLS DR STE 115
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-3388
Mailing Address - Country:US
Mailing Address - Phone:602-368-3448
Mailing Address - Fax:602-357-3323
Practice Address - Street 1:4045 E UNION HILLS DR STE 115
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050
Practice Address - Country:US
Practice Address - Phone:602-368-3448
Practice Address - Fax:602-357-3323
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32803207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00179455OtherRAILROAD MEDICARE
AZ82606Medicare PIN
AZP00179455OtherRAILROAD MEDICARE
AZH25809Medicare UPIN
AZ82600Medicare PIN