MEDICARE: SHARATH KUMAR REDDY BEERAM

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
1	225100000X	Physical Therapist	5501302040	MI

General Provider Information

NPI Number	:	1710623962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARATH KUMAR REDDY BEERAM

Provider Business Mailing Address
First Line	:	24730 ROOSEVELT CT APT 316
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48335-1863
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	38765 MOUND RD STE 101
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3209
Country	:	US
Telephone Number	:	586-554-7834
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2022
Last Update Date	:	05/10/2022

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