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NPI Code Detail

MEDICARE: DR. CHARLES SKARDARASY M.D.

MEDICARE: DR. CHARLES SKARDARASY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician047519MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386618882
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES SKARDARASY M.D.
Provider Business Mailing Address
First Line : 33464 SCHOENHERR RD
Second Line : SUITE 160
City : STERLING HEIGHTS
State : MI
Zip : 48312-6314
Country : US
Telephone Number : 586-258-3775
Fax Number : 586-258-3782
Provider Business Practice Location Address
First Line : 33464 SCHOENHERR RD
Second Line : SUITE 160
City : STERLING HEIGHTS
State : MI
Zip : 48312-6314
Country : US
Telephone Number : 586-258-3775
Fax Number : 586-258-3782
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2006
Last Update Date : 10/20/2009

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