Provider Demographics
NPI:1275592537
Name:DESKINS, SHARON (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:DESKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 HOLLYWOOD RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9159
Mailing Address - Country:US
Mailing Address - Phone:269-982-7840
Mailing Address - Fax:269-982-7843
Practice Address - Street 1:3950 HOLLYWOOD RD
Practice Address - Street 2:SUITE 270
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9159
Practice Address - Country:US
Practice Address - Phone:269-982-7840
Practice Address - Fax:269-982-7843
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISD062237207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0A110280OtherBCBS
MI110203219OtherRAIL ROAD MEDICARE
MI0A110280OtherBCBS
MI110203219OtherRAIL ROAD MEDICARE
MI0M94300Medicare PIN