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Individual

ELIZABETH SHARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ATC

Contact information

Practice address
15520 19 MILE RD STE 450, CLINTON TWP, MI 48038-6332
(586) 416-2000
(586) 416-2013
Mailing address
33900 HARPER AVE STE 104, CLINTON TWP, MI 48035-4258

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2601001454
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2601001454
STATE OF MICHIGAN
MI
Enumeration date
10/13/2015
Last updated
02/18/2025
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