MEDICARE: VENKATA KRISHNA SHARMA MD

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	2084P0015X	Psychosomatic Medicine Physician	21846	WI
2	2084P0800X	Psychiatry Physician	21846	WI

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	:	1801895743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VENKATA KRISHNA SHARMA MD

Provider Business Mailing Address
First Line	:	3535 30TH AVE
Second Line	:	SUITE 201
City	:	KENOSHA
State	:	WI
Zip	:	53144
Country	:	US
Telephone Number	:	262-652-7813
Fax Number	:	262-652-4450

Provider Business Practice Location Address
First Line	:	3535 30TH AVE
Second Line	:	SUITE 201
City	:	KENOSHA
State	:	WI
Zip	:	53144
Country	:	US
Telephone Number	:	262-652-7813
Fax Number	:	262-652-4450

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	09/07/2007

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