Healthcare Provider Details

I. General information

NPI: 1932604238
Provider Name (Legal Business Name): RISHI SHARMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N MICHIGAN ST
SOUTH BEND IN
46601-1033
US

IV. Provider business mailing address

PO BOX 1258
SOUTH BEND IN
46624-1258
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-1000
  • Fax:
Mailing address:
  • Phone: 574-258-1100
  • Fax: 574-258-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number02007271A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036157325
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: