Gretta Shara, DPM, PC
Organization Active NPI Podiatrist · Armada, MI
NPI 1003074089 · NPPES record last updated Mar 31, 2009
Key facts
- NPI
- 1003074089
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Podiatrist 213E00000X
- License
- 5901001789 (MI)
- Legal business name
- GRETTA SHARA, DPM, PC
- Practice address
- 23064 E Main St
Armada, MI 48005-4705 - Phone
- (586) 784-0184
- Fax
- (586) 784-5227
- NPI assigned
- May 27, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Gretta Shara, DPM
- Title
- President
- Phone
- (586) 784-0184
Practitioners 1
-
Gretta Shara, DPM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080728000172 | MI | Part B Supplier - Clinic/Group Practice | 7416020292 |
Receives reassigned benefits from 1 practitioner Practice locations: Armada, MI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist |
213E00000X | 5901001789 | MI | Yes |
| Podiatric Clinic/Center | 261QP1100X | MI | ||
| Durable Medical Equipment & Medical Supplies | 332B00000X | 5901001789 | MI |
Addresses
Primary practice location
23064 E Main St
Armada, MI 48005-4705
Mailing address
PO Box 907
Armada, MI 48005-0907
Phone (586) 784-0184
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 540E001930 | Other | MI | BCBSDME |
| 480E027910 | Other | MI | BCBS GROUP PIN |
Other names
- Armada Foot and Ankle Clinic
Other providers in Armada, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.