Healthcare Provider Details

I. General information

NPI: 1013968395
Provider Name (Legal Business Name): KAILASH C. SHARMA MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6360 159TH ST SUITE A B
OAK FOREST IL
60452-2725
US

IV. Provider business mailing address

7891 BROADWAY STE A
MERRILLVILLE IN
46410-5556
US

V. Phone/Fax

Practice location:
  • Phone: 708-687-4620
  • Fax: 708-687-4625
Mailing address:
  • Phone: 219-756-3988
  • Fax: 219-756-2595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-094003
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036-094003
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036-094003
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number036-094003
License Number StateIL

VIII. Authorized Official

Name: KAILASH C. SHARMA
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 708-687-4620