Healthcare Provider Details

I. General information

NPI: 1336304856
Provider Name (Legal Business Name): ARUN SHARMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N BOND ST
SPRINGFIELD IL
62702-4952
US

IV. Provider business mailing address

PO BOX 19662
SPRINGFIELD IL
62794-9662
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-0253
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-0253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036-138707
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: