Provider Demographics
NPI:1871648576
Name:CABANSAG, SHARON (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:CABANSAG
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 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4600 BRETON RD SE
Practice Address - Street 2:SUITE 102
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-5262
Practice Address - Country:US
Practice Address - Phone:616-391-9700
Practice Address - Fax:616-391-9707
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0807510561OtherBCBS OF MICHIGAN
1463499OtherCIGNA
MI382243753OtherPPOM
MI7028920OtherAETNA
MI0131451OtherIBA
MI4301080148Medicaid
1463499OtherCIGNA
MI0131451OtherIBA