Provider Demographics
NPI:1518937762
Name:SHARMA, MEENAKSHI (MD)
Entity Type:Individual
Prefix:
First Name:MEENAKSHI
Middle Name:
Last Name:SHARMA
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 1:24681 NORTHWESTERN HWY
Mailing Address - Street 2:STE. 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2305
Mailing Address - Country:US
Mailing Address - Phone:248-324-0700
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:24681 NORTHWESTERN HWY
Practice Address - Street 2:STE. 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2305
Practice Address - Country:US
Practice Address - Phone:248-324-0700
Practice Address - Fax:248-324-1477
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084508207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4807970Medicaid
MI0F37432157Medicare ID - Type Unspecified
MI4807970Medicaid