Provider Demographics
NPI:1497829659
Name:SURA SHARQE ENDOCRINOLOGY, INC
Entity Type:Organization
Organization Name:SURA SHARQE ENDOCRINOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOMIN
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:GABIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-825-0237
Mailing Address - Street 1:PO BOX 72327
Mailing Address - Street 2:SURA SHARQE ENDOCRINOLOGY, INC
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-1023
Mailing Address - Country:US
Mailing Address - Phone:623-825-0237
Mailing Address - Fax:480-361-1503
Practice Address - Street 1:6525 W. SACK DRIVE
Practice Address - Street 2:#204
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:623-825-0237
Practice Address - Fax:623-825-0271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RE0101X
AZ28217207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ56505401Medicaid
AZ565054Medicaid
H36146Medicare UPIN
AZZ83446Medicare PIN
AZH36146Medicare UPIN