Healthcare Provider Details

I. General information

NPI: 1659699189
Provider Name (Legal Business Name): RAVNITA SHARMA-ROBERTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAVNITA SHARMA MD

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE
JACKSON MI
49201
US

IV. Provider business mailing address

PO BOX 67000, DEPARTMENT 272801
DETROIT MI
48267-0001
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-4800
  • Fax: 517-205-5903
Mailing address:
  • Phone: 517-205-3867
  • Fax: 517-803-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301095740
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: