Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 4301059313 | MI |
Y | 111NI0900X | Internist | 4301059313 | MI |
N | 207U00000X | Nuclear Medicine Specialist | 4301059313 | MI |
NPI | 1194836858 |
---|---|
Provider Name | Manish Sharma |
First Address | Kalamazoo, MI 49007-5341 |
Second Address | Kalamazoo, MI 49007-5341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 12/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110F364771 | BCBS GROUP PIN (01) | MI |
1194836858 | (05) | MI |
G34800 | (02) |