MEDICARE: MRS. RUTH SHARP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	L777466	MI
2	332BC3200X	Customized Equipment (DME)	L777466	MI
3	335E00000X	Prosthetic/Orthotic Supplier	L777466	MI

General Provider Information

NPI Number	:	1255784013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RUTH SHARP

Provider Business Mailing Address
First Line	:	2845 CROOKS RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-3661
Country	:	US
Telephone Number	:	248-829-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 N MACOMB ST
Second Line	:
City	:	MONROE
State	:	MI
Zip	:	48162-2929
Country	:	US
Telephone Number	:	734-523-6928
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2016
Last Update Date	:	07/18/2016

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Directions to “ MRS. RUTH SHARP ” Practice Location

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