MEDICARE: KAILASH C. SHARMA MD SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	01061460A	IL
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	01061460A	IL
3	207RS0012X	Sleep Medicine (Internal Medicine) Physician	01061460A	IL
4	207RP1001X	Pulmonary Disease Physician	01061460A	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01632588	OTHER	IL	GROUP BLUE SHIELD NUMBER
2	01632588	OTHER	IL	BLUE SHIELD PPO #

General Provider Information

NPI Number	:	1073776852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAILASH C. SHARMA MD SC

Provider Business Mailing Address
First Line	:	7895 BROADWAY STE V
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-5529
Country	:	US
Telephone Number	:	219-756-3988
Fax Number	:	219-756-2595

Provider Business Practice Location Address
First Line	:	20635 ABBEY WOODS CT N
Second Line	:	SUITE 101 & 102
City	:	FRANKFORT
State	:	IL
Zip	:	60423-3181
Country	:	US
Telephone Number	:	708-687-4620
Fax Number	:	708-687-4625

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	KAILASH C. SHARMA
Credential	:	M.D.
Telephone Number	:	708-687-4620

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	07/02/2008

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