Provider Demographics
NPI:1962452524
Name:BISHAI, SHARIFF K (DO)
Entity Type:Individual
Prefix:
First Name:SHARIFF
Middle Name:K
Last Name:BISHAI
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:24715 LITTLE MACK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3207
Mailing Address - Country:US
Mailing Address - Phone:586-779-7870
Mailing Address - Fax:586-779-7748
Practice Address - Street 1:24715 LITTLE MACK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-3207
Practice Address - Country:US
Practice Address - Phone:586-779-7870
Practice Address - Fax:586-779-7748
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-02-19
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Provider Licenses
StateLicense IDTaxonomies
CT044107207X00000X
NY238944207X00000X
MI5101014863207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MII53925Medicare UPIN