Provider Demographics
NPI:1578566832
Name:SHARMA, JAGMOHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAGMOHAN
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43555 DALCOMA DR
Mailing Address - Street 2:STE 4
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6310
Mailing Address - Country:US
Mailing Address - Phone:586-228-2882
Mailing Address - Fax:586-463-7152
Practice Address - Street 1:43555 DALCOMA DR
Practice Address - Street 2:STE 4
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6310
Practice Address - Country:US
Practice Address - Phone:586-228-2882
Practice Address - Fax:586-463-7152
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4302073101208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104083075Medicaid
MI2505228341OtherBCN
MIC6810OtherM-CARE
MIJS073101OtherBCBSM
MI123905OtherCARE CHOICES-PREFERRED
MI250010321OtherRAILROAD MEDICARE
MI2505228341OtherBCN
MI123905OtherCARE CHOICES-PREFERRED