Provider Demographics
NPI:1588119689
Name:SHARMA, SETU (RPT)
Entity type:Individual
Prefix:
First Name:SETU
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24901 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 113
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2203
Mailing Address - Country:US
Mailing Address - Phone:947-282-8575
Mailing Address - Fax:947-285-8576
Practice Address - Street 1:24901 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 113
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2203
Practice Address - Country:US
Practice Address - Phone:947-282-8575
Practice Address - Fax:947-285-8576
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014935225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicare PIN