Provider Demographics
NPI:1386618882
Name:SKARDARASY, CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:SKARDARASY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33464 SCHOENHERR RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-6314
Mailing Address - Country:US
Mailing Address - Phone:586-258-3775
Mailing Address - Fax:586-258-3782
Practice Address - Street 1:33464 SCHOENHERR RD
Practice Address - Street 2:SUITE 160
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-6314
Practice Address - Country:US
Practice Address - Phone:586-258-3775
Practice Address - Fax:586-258-3782
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI047519207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1789690Medicaid
MIB45389Medicare UPIN
MI0502770Medicare ID - Type Unspecified