Healthcare Provider Details

I. General information

NPI: 1982691846
Provider Name (Legal Business Name): RITA KHANEJA-SHARROW D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29600 S WIXOM RD
WIXOM MI
48393-3430
US

IV. Provider business mailing address

29600 S WIXOM RD
WIXOM MI
48393-3430
US

V. Phone/Fax

Practice location:
  • Phone: 248-668-1900
  • Fax: 248-668-1905
Mailing address:
  • Phone: 248-668-1900
  • Fax: 248-668-1905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101015028
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5315012473
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: