Healthcare Provider Details

I. General information

NPI: 1164773560
Provider Name (Legal Business Name): KULBHUSHAN K. SHARMA MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 W THUNDERBIRD RD SUITE D-2
GLENDALE AZ
85306-4636
US

IV. Provider business mailing address

5620 W THUNDERBIRD RD SUITE D-2
GLENDALE AZ
85306-4636
US

V. Phone/Fax

Practice location:
  • Phone: 602-298-9741
  • Fax: 602-298-9745
Mailing address:
  • Phone: 602-298-9741
  • Fax: 602-298-9745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number22286
License Number StateAZ

VIII. Authorized Official

Name: PURNIMA SHARMA
Title or Position: OFFICE MANAGER
Credential:
Phone: 602-330-7465