Healthcare Provider Details

I. General information

NPI: 1003074089
Provider Name (Legal Business Name): GRETTA SHARA, DPM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 03/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23064 E MAIN ST
ARMADA MI
48005-4705
US

IV. Provider business mailing address

PO BOX 907
ARMADA MI
48005-0907
US

V. Phone/Fax

Practice location:
  • Phone: 586-784-0184
  • Fax: 586-784-5227
Mailing address:
  • Phone: 586-784-0184
  • Fax: 586-784-5227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901001789
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5901001789
License Number StateMI

VIII. Authorized Official

Name: DR. GRETTA SHARA
Title or Position: PRESIDENT
Credential: DPM
Phone: 586-784-0184