Healthcare Provider Details

I. General information

NPI: 1982758140
Provider Name (Legal Business Name): SHARP MEDICAL PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 02/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N DETROIT ST
LAGRANGE IN
46761
US

IV. Provider business mailing address

2600 N DETROIT ST PO BOX 168
LAGRANGE IN
46761
US

V. Phone/Fax

Practice location:
  • Phone: 260-463-4896
  • Fax: 260-463-5242
Mailing address:
  • Phone: 260-463-4896
  • Fax: 260-463-5242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1047132
License Number StateIN

VIII. Authorized Official

Name: DR. RHONDA LEE SHARP
Title or Position: OWNER PHYSICIAN
Credential: MD
Phone: 260-463-4896