Provider Demographics
NPI:1912155789
Name:SHARAPOV, ANTON A (MD)
Entity type:Individual
Prefix:
First Name:ANTON
Middle Name:A
Last Name:SHARAPOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANTON
Other - Middle Name:A
Other - Last Name:CHARAPOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:521 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2266
Mailing Address - Country:US
Mailing Address - Phone:231-487-1900
Mailing Address - Fax:231-348-0984
Practice Address - Street 1:521 MONROE ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2266
Practice Address - Country:US
Practice Address - Phone:231-487-1900
Practice Address - Fax:231-348-0984
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51639-20208600000X
MI4301095918208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
202550005Medicare PIN