Healthcare Provider Details

I. General information

NPI: 1730717521
Provider Name (Legal Business Name): KUSHAGRA SHARMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 NAPIER AVE
SAINT JOSEPH MI
49085-2112
US

IV. Provider business mailing address

1234 NAPIER AVE
SAINT JOSEPH MI
49085-2112
US

V. Phone/Fax

Practice location:
  • Phone: 269-982-4941
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberH0107367
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: