Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 4301067180 | MI |
NPI | 1013900570 |
---|---|
Provider Name | Mamta Sharma |
First Address | Clinton Twp, MI 48038-1136 |
Second Address | Grosse Pointe Woods, MI 48236-2893 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2005 |
Last Update Date | 09/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05274626 | ECFMG (01) | |
4301067180 | CONTROLLED SUBSTANCE (01) | |
4466620 | (05) | MI |
H67680 | (02) |