MEDICARE: BUTHEINAH A AL-SHARAFI MD

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	4301080585	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1107402142	OTHER	MI	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922094556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BUTHEINAH A AL-SHARAFI MD

Provider Business Mailing Address
First Line	:	4190 24TH AVE
Second Line	:	SUITE:201
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-3882
Country	:	US
Telephone Number	:	810-989-7478
Fax Number	:	810-989-7644

Provider Business Practice Location Address
First Line	:	4190 24TH AVE
Second Line	:	SUITE:201
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-3882
Country	:	US
Telephone Number	:	810-989-7478
Fax Number	:	810-989-7644

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	07/08/2007

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