Provider Demographics
NPI:1538171913
Name:SHARMA, SOORYA KANT (MD)
Entity type:Individual
Prefix:DR
First Name:SOORYA
Middle Name:KANT
Last Name:SHARMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1630 FLOWERS MILL DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9694
Mailing Address - Country:US
Mailing Address - Phone:616-361-3613
Mailing Address - Fax:616-361-3613
Practice Address - Street 1:2660 44TH ST SW
Practice Address - Street 2:SUITE 100
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-6837
Practice Address - Country:US
Practice Address - Phone:616-974-9760
Practice Address - Fax:616-974-9769
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301065270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4467117Medicaid
G72795Medicare UPIN
MI0N99140Medicare ID - Type Unspecified