MEDICARE: DR. KAILASH C. SHARMA M.D.

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	036094003	IL
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	036094003	IL
3	207RP1001X	Pulmonary Disease Physician	036094003	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407855083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAILASH C. SHARMA M.D.

Provider Business Mailing Address
First Line	:	6360 159TH ST STE A-B
Second Line	:
City	:	OAK FOREST
State	:	IL
Zip	:	60452-2725
Country	:	US
Telephone Number	:	708-687-4620
Fax Number	:	708-687-4625

Provider Business Practice Location Address
First Line	:	6360 159TH ST
Second Line	:	SUITE A-B
City	:	OAK FOREST
State	:	IL
Zip	:	60452-2725
Country	:	US
Telephone Number	:	708-687-4620
Fax Number	:	708-687-4625

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	10/30/2019

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