Healthcare Provider Details

I. General information

NPI: 1316177587
Provider Name (Legal Business Name): ANKUR SHARMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 09/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST SUITE 3500
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

3100 THEODORE ST SUITE 201
JOLIET IL
60435
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3014
  • Fax: 916-734-7920
Mailing address:
  • Phone: 815-744-5550
  • Fax: 815-744-5428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA119014
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberL1501570
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036.134375
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: