=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689107393
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZEESHAN SHARIF M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2017
-----------------------------------------------------
Last Update Date | 10/26/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1715 NORTHFIELD DR
-----------------------------------------------------
City | ROCHESTER HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48309-3819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-888-8888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 461 W HURON ST 3RD FLOOR SOUTH
-----------------------------------------------------
City | PONTIAC
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48341-1601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-857-6736
-----------------------------------------------------
Fax | 248-857-6767
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 4301502582
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------