Provider Demographics
NPI:1396740817
Name:SHARMA, DEVENDRA K (MD)
Entity type:Individual
Prefix:DR
First Name:DEVENDRA
Middle Name:K
Last Name:SHARMA
Suffix:
Gender:M
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:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0369
Mailing Address - Country:US
Mailing Address - Phone:989-362-3447
Mailing Address - Fax:
Practice Address - Street 1:541 LAKE STREET
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763
Practice Address - Country:US
Practice Address - Phone:989-362-3447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033122207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382338336102OtherCOMMUNITY CHOICE MI
MICC00000010OtherHEALTHPLUS OF MI
MI2897941OtherMOLINA HEALTHCARE MI
MI080012620 L0601OtherBLUE CARE NETWORK
MI0803518971OtherBCBSM
MI2897941Medicaid
MI0803518971OtherBCBSM
MIP61730001Medicare PIN