MEDICARE: SHARA GROVER MD LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1942660170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARA GROVER MD LLC

Provider Business Mailing Address
First Line	:	305 EAGLE LAKE AVE
Second Line	:
City	:	MUKWONAGO
State	:	WI
Zip	:	53149-1163
Country	:	US
Telephone Number	:	262-363-5719
Fax Number	:	262-363-9763

Provider Business Practice Location Address
First Line	:	305 EAGLE LAKE AVE
Second Line	:
City	:	MUKWONAGO
State	:	WI
Zip	:	53149-1163
Country	:	US
Telephone Number	:	262-363-5719
Fax Number	:	262-363-9763

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHARA GROVER
Credential	:	M.D.
Telephone Number	:	312-498-0701

Provider Enumeration Date	:	03/01/2016
Last Update Date	:	03/01/2016

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