Individual
SHEREZADE KHAMBATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
50505 SCHOENHERR RD, STE 320, SHELBY TOWNSHIP, MI 48315-3141
(586) 580-3062
(586) 580-3143
Mailing address
50505 SCHOENHERR RD, STE 320, SHELBY TOWNSHIP, MI 48315-3141
(586) 580-3062
(586) 580-3143
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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