Healthcare Provider Details

I. General information

NPI: 1053321141
Provider Name (Legal Business Name): AZRA SHIBLI SHERIFF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9128 COLUMBIA AVE STE A
MUNSTER IN
46321-2600
US

IV. Provider business mailing address

9128 COLUMBIA AVE STE A
MUNSTER IN
46321-2600
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-2730
  • Fax: 219-836-0244
Mailing address:
  • Phone: 219-836-2730
  • Fax: 219-836-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01032560
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01032560
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: