Healthcare Provider Details

I. General information

NPI: 1437646973
Provider Name (Legal Business Name): NEIL KANT SHARMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W PARK ST
URBANA IL
61801-2501
US

IV. Provider business mailing address

611 W PARK ST FAPC
URBANA IL
61820
US

V. Phone/Fax

Practice location:
  • Phone: 217-383-3440
  • Fax: 217-383-3171
Mailing address:
  • Phone: 217-902-6954
  • Fax: 217-902-7711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number036170804
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number036170804
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036170804
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: