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General NPI Number Information
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NPI Number | 1982758140
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Entity Type | Organization
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Legal Business Name | SHARP MEDICAL PRACTICE
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 02/15/2010
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Provider Practice Location Address
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Address Line | 2600 N DETROIT ST
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City | LAGRANGE
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State | IN
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Zip | 46761
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Country | US
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Telephone | 260-463-4896
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Fax | 260-463-5242
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Provider Business Mailing Address
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Address Line | 2600 N DETROIT ST PO BOX 168
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City | LAGRANGE
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State | IN
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Zip | 46761
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Country | US
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Telephone | 260-463-4896
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Fax | 260-463-5242
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | DR. RHONDA LEE SHARP
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Credential | MD
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Telephone | 260-463-4896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1047132
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License Number State | IN
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