MEDICARE: REGINALD DENNIS SHARPE D.O.

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	207VG0400X	Gynecology Physician	5101010839	MI

General Provider Information

NPI Number	:	1699976175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINALD DENNIS SHARPE D.O.

Provider Business Mailing Address
First Line	:	15515 WINDMILL POINTE DR
Second Line	:
City	:	GROSSE POINTE PARK
State	:	MI
Zip	:	48230-1856
Country	:	US
Telephone Number	:	313-580-0660
Fax Number	:	734-261-2748

Provider Business Practice Location Address
First Line	:	27549 6 MILE RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48152-3834
Country	:	US
Telephone Number	:	734-261-3430
Fax Number	:	734-261-2748

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/08/2007

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