Provider Demographics
NPI:1538146816
Name:SHARAF, BELAL MOHAMMAD (MD)
Entity type:Individual
Prefix:
First Name:BELAL
Middle Name:MOHAMMAD
Last Name:SHARAF
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 1:1753 AIRWAY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3720
Mailing Address - Country:US
Mailing Address - Phone:928-757-4359
Mailing Address - Fax:928-757-2481
Practice Address - Street 1:1753 AIRWAY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3720
Practice Address - Country:US
Practice Address - Phone:928-757-4359
Practice Address - Fax:928-757-2481
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33197174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ974601OtherAHCCCS
AZ974601OtherAHCCCS
AZ105474Medicare ID - Type UnspecifiedMEDICARE NUMBER