Provider Demographics
NPI:1922094556
Name:AL-SHARAFI, BUTHEINAH A (MD)
Entity Type:Individual
Prefix:
First Name:BUTHEINAH
Middle Name:A
Last Name:AL-SHARAFI
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 1:4190 24TH AVE
Mailing Address - Street 2:SUITE:201
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3882
Mailing Address - Country:US
Mailing Address - Phone:810-989-7478
Mailing Address - Fax:810-989-7644
Practice Address - Street 1:4190 24TH AVE
Practice Address - Street 2:SUITE:201
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3882
Practice Address - Country:US
Practice Address - Phone:810-989-7478
Practice Address - Fax:810-989-7644
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080585207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1107402142OtherBLUE CROSS BLUE SHIELD
MI4443518Medicaid
MI4443518Medicaid
MIOM55260003Medicare ID - Type Unspecified