Individual
SHEREZADE KHAMBATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
5101019075
MI
207RI0011X
Interventional Cardiology Physician
Primary
5101019075
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790949741
—
MI
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
01
—
P00839001
RAILROAD MEDICARE
MN
Enumeration date
07/17/2008
Last updated
10/12/2023
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