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General NPI Number Information
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NPI Number | 1679535942
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Entity Type | Individual
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Provider Name | GRETTA SHARA DPM
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Gender | Female
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 10/06/2008
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Provider Practice Location Address
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Address Line | 23064 E MAIN ST
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City | ARMADA
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State | MI
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Zip | 48005-4705
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Country | US
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Telephone | 586-784-0184
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Fax | 586-784-5227
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Provider Business Mailing Address
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Address Line | PO BOX 907
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City | ARMADA
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State | MI
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Zip | 48005-0907
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Country | US
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Telephone | 586-784-0184
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Fax | 586-784-5227
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 5901001789
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5901001789
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License Number State | MI
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