Healthcare Provider Details

I. General information

NPI: 1578511028
Provider Name (Legal Business Name): ANJMUN SHARMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 W BAPTIST RD STE 100
COLORADO SPRINGS CO
80921-2480
US

IV. Provider business mailing address

9820 PALISADE RIDGE DR
COLORADO SPRINGS CO
80920-1490
US

V. Phone/Fax

Practice location:
  • Phone: 719-445-9852
  • Fax: 719-426-9796
Mailing address:
  • Phone: 719-313-8401
  • Fax: 888-390-1539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46192
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number46192
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35086983
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC-173714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: