Provider Demographics
NPI:1629632906
Name:SHARMA, SOURABH
Entity Type:Individual
Prefix:
First Name:SOURABH
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3980 JOHN R, 7-BRUSH N. MB#165
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-993-4030
Mailing Address - Fax:313-993-4116
Practice Address - Street 1:DETROIT MEDICAL CENTER, HUTZEL WOMEN'S HOSPITAL
Practice Address - Street 2:3980 JOHN R, 7-BRUSH NORTH
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-993-4030
Practice Address - Fax:313-993-4116
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU5813207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty