Individual
GHOLAMREZA SHAREGHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3408 MILLER RD, SUITE 301, KALAMAZOO, MI 49001
(269) 720-9702
(269) 350-5030
Mailing address
3408 MILLER RD, SUITE 301, KALAMAZOO, MI 49001-0001
(269) 720-9702
(269) 350-5030
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301055253
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0501200701
BLUE CROSS BLUE SHIELD
MI
01
—
0501311531
BCBS
MI
01
—
200000006384
PHP
MI
05
—
4645774
—
MI
Enumeration date
05/11/2006
Last updated
07/15/2013
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