Healthcare Provider Details

I. General information

NPI: 1669735734
Provider Name (Legal Business Name): SHISHIR SHARMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 W RANDOL MILL RD STE 200
ARLINGTON TX
76012-2581
US

IV. Provider business mailing address

16980 DALLAS PKWY STE 200
DALLAS TX
75248-1974
US

V. Phone/Fax

Practice location:
  • Phone: 817-461-3003
  • Fax: 844-290-4365
Mailing address:
  • Phone: 972-391-1915
  • Fax: 844-290-4365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125061820
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberR5643
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberR5643
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: