Provider Demographics
NPI:1053321141
Name:SHERIFF, AZRA SHIBLI (MD)
Entity Type:Individual
Prefix:MRS
First Name:AZRA
Middle Name:SHIBLI
Last Name:SHERIFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9128 COLUMBIA AVE
Mailing Address - Street 2:STE A
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2600
Mailing Address - Country:US
Mailing Address - Phone:219-836-2730
Mailing Address - Fax:219-836-0244
Practice Address - Street 1:9128 COLUMBIA AVE
Practice Address - Street 2:STE A
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2600
Practice Address - Country:US
Practice Address - Phone:219-836-2730
Practice Address - Fax:219-836-0244
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032560208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100212430AMedicaid