Healthcare Provider Details

I. General information

NPI: 1255632642
Provider Name (Legal Business Name): MICHAEL KURT SHARP AU.D., CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEMORIAL HALL, SECOND FLOOR W MURRAY ST
MACOMB IL
61455
US

IV. Provider business mailing address

1 UNIVERSITY CIR
MACOMB IL
61455-1390
US

V. Phone/Fax

Practice location:
  • Phone: 309-298-1955
  • Fax:
Mailing address:
  • Phone: 309-298-1955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147.001883
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number147.001338
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: