Healthcare Provider Details

I. General information

NPI: 1558331447
Provider Name (Legal Business Name): ELIAS I SHARBA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18181 OAKWOOD BLVD SUITE 208
DEARBORN MI
48124-5032
US

IV. Provider business mailing address

18181 OAKWOOD BLVD SUITE 208
DEARBORN MI
48124-5032
US

V. Phone/Fax

Practice location:
  • Phone: 313-271-5565
  • Fax: 313-271-1053
Mailing address:
  • Phone: 313-271-5565
  • Fax: 313-271-1053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number01049564A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number01049564A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01049564A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number4301059467
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: