Healthcare Provider Details

I. General information

NPI: 1801587159
Provider Name (Legal Business Name): SARTHAK KULSHRESHTHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 E STATE ST
ROCKFORD IL
61104
US

IV. Provider business mailing address

MILE SQUARE LP JOHNSON CENTER 1221 E. STATE ST.
ROCKFORD IL
61104
US

V. Phone/Fax

Practice location:
  • Phone: 815-972-1000
  • Fax:
Mailing address:
  • Phone: 815-972-1037
  • Fax: 815-972-1092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036179844
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: