Provider Demographics
NPI:1790920429
Name:FOSTER, SHARMARA CHRIS
Entity Type:Individual
Prefix:
First Name:SHARMARA
Middle Name:CHRIS
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 HAZELWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1715
Mailing Address - Country:US
Mailing Address - Phone:313-742-9787
Mailing Address - Fax:
Practice Address - Street 1:671 HAZELWOOD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1715
Practice Address - Country:US
Practice Address - Phone:313-742-9787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1922768Medicaid