Provider Demographics
NPI:1205817038
Name:SHARMA, RITA A (MD)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:A
Last Name:SHARMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29829 TELEGRAPH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034
Mailing Address - Country:US
Mailing Address - Phone:248-355-3033
Mailing Address - Fax:248-355-4936
Practice Address - Street 1:29829 TELEGRAPH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034
Practice Address - Country:US
Practice Address - Phone:248-355-3033
Practice Address - Fax:248-355-4936
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRS057583207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICB0701OtherMEDICARE RAIL ROAD
MIRS057583OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MICB0701OtherMEDICARE RAIL ROAD
MIRS057583OtherBLUE CROSS BLUE SHIELD OF MICHIGAN