Healthcare Provider Details

I. General information

NPI: 1033278056
Provider Name (Legal Business Name): SAMEER SHARMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CALUMET AVE
DYER IN
46311-1596
US

IV. Provider business mailing address

195 N HARBOR DR #2908
CHICAGO IL
60601-7514
US

V. Phone/Fax

Practice location:
  • Phone: 219-864-2086
  • Fax:
Mailing address:
  • Phone: 312-523-6837
  • Fax: 312-552-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036-114090
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number036-114090
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number01065059A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: