MEDICARE: DR. RITA KHANEJA-SHARROW D.O.

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	207Q00000X	Family Medicine Physician	5101015028	MI
2	207Q00000X	Family Medicine Physician	5315012473	MI

General Provider Information

NPI Number	:	1982691846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RITA KHANEJA-SHARROW D.O.

Provider Business Mailing Address
First Line	:	29600 S WIXOM RD
Second Line	:
City	:	WIXOM
State	:	MI
Zip	:	48393-3430
Country	:	US
Telephone Number	:	248-668-1900
Fax Number	:	248-668-1905

Provider Business Practice Location Address
First Line	:	29600 S WIXOM RD
Second Line	:
City	:	WIXOM
State	:	MI
Zip	:	48393-3430
Country	:	US
Telephone Number	:	248-668-1900
Fax Number	:	248-668-1905

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	07/08/2007

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