Provider Demographics
NPI:1740510619
Name:CHARLES SKARDARASY, MD, PC
Entity type:Organization
Organization Name:CHARLES SKARDARASY, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, PC
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SKARDARASY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-258-3775
Mailing Address - Street 1:33464 SCHOENHERR RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-6314
Mailing Address - Country:US
Mailing Address - Phone:586-258-3775
Mailing Address - Fax:586-258-3782
Practice Address - Street 1:33464 SCHOENHERR RD
Practice Address - Street 2:SUITE 160
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-6314
Practice Address - Country:US
Practice Address - Phone:586-258-3775
Practice Address - Fax:586-258-3782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047519207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty