=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619053881
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VK SHARMA MD SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2006
-----------------------------------------------------
Last Update Date | 09/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3535 30TH AVE SUITE 201
-----------------------------------------------------
City | KENOSHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-652-7813
-----------------------------------------------------
Fax | 262-652-4450
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3535 30TH AVE SUITE 201
-----------------------------------------------------
City | KENOSHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-652-7813
-----------------------------------------------------
Fax | 262-652-4450
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | VENKATA K SHARMA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 262-652-7813
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 21846
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------