MEDICARE: DR. MOHAMMED EL-SHAREIF D.D.S.

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	1223G0001X	General Practice Dentistry	2901018296	MI

General Provider Information

NPI Number	:	1598980120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMED EL-SHAREIF D.D.S.

Provider Business Mailing Address
First Line	:	3089 CREEK DR SE
Second Line	:	APT. 3-A
City	:	KENTWOOD
State	:	MI
Zip	:	49512-8159
Country	:	US
Telephone Number	:	616-245-2767
Fax Number	:	616-245-0498

Provider Business Practice Location Address
First Line	:	2020 DIVISION AVE S
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49507-3029
Country	:	US
Telephone Number	:	616-245-2767
Fax Number	:	616-245-0498

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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