Healthcare Provider Details

I. General information

NPI: 1912155789
Provider Name (Legal Business Name): ANTON A. SHARAPOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANTON A. CHARAPOV

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 MONROE ST
PETOSKEY MI
49770-2266
US

IV. Provider business mailing address

521 MONROE ST
PETOSKEY MI
49770-2266
US

V. Phone/Fax

Practice location:
  • Phone: 231-487-1900
  • Fax: 231-348-0984
Mailing address:
  • Phone: 231-487-1900
  • Fax: 231-348-0984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number51639-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301095918
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: