Provider Demographics
NPI:1982613915
Name:TANDON-SHARMA, JAISHREE (MD)
Entity Type:Individual
Prefix:
First Name:JAISHREE
Middle Name:
Last Name:TANDON-SHARMA
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 1:8447 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1888
Mailing Address - Country:US
Mailing Address - Phone:810-695-1992
Mailing Address - Fax:810-695-2664
Practice Address - Street 1:8447 HOLLY RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1888
Practice Address - Country:US
Practice Address - Phone:810-695-1992
Practice Address - Fax:810-695-2664
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2010-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073664207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1982613915Medicaid
MIJT073664OtherBC/BS OF MICHIGAN
MIM23560227Medicare PIN
MIH10577Medicare UPIN