Healthcare Provider Details

I. General information

NPI: 1356245021
Provider Name (Legal Business Name): MICHAEL J SHARP CP-C, NREMT-P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11033 W 93RD AVE
SAINT JOHN IN
46373-9701
US

IV. Provider business mailing address

11033 W 93RD AVE
SAINT JOHN IN
46373-9701
US

V. Phone/Fax

Practice location:
  • Phone: 219-365-6034
  • Fax:
Mailing address:
  • Phone: 219-365-6034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2879-6143
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: