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General NPI Number Information
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NPI Number | 1629136064
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Entity Type | Individual
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Provider Name | SHAM JURATLI M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 18181 OAKWOOD BLVD. SUITE 206
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City | DEARBORN
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State | MI
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Zip | 48124
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Country | US
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Telephone | 313-451-8253
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Fax | 313-451-8351
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Provider Business Mailing Address
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Address Line | P.O. BOX 250712
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City | FRANKLIN
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State | MI
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Zip | 48025
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Country | US
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Telephone | 313-451-8253
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Fax | 313-451-8351
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301091001
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License Number State | MI
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