Healthcare Provider Details

I. General information

NPI: 1629464243
Provider Name (Legal Business Name): MOHAMED OMER SHARIF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 RALSTON AVE
DEFIANCE OH
43512-1396
US

IV. Provider business mailing address

9003 GREEK PALACE AVE
LAS VEGAS NV
89178-7574
US

V. Phone/Fax

Practice location:
  • Phone: 419-783-6955
  • Fax:
Mailing address:
  • Phone: 702-882-2267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number73700
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA167675
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2019-02152
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: