Provider Demographics
NPI:1043549579
Name:BANSI.D.SHARMA MD SC
Entity Type:Organization
Organization Name:BANSI.D.SHARMA MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BANSI
Authorized Official - Middle Name:DHAR
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-799-1780
Mailing Address - Street 1:17577 KEDZIE AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2051
Mailing Address - Country:US
Mailing Address - Phone:708-799-1780
Mailing Address - Fax:708-799-4914
Practice Address - Street 1:17577 KEDZIE AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2051
Practice Address - Country:US
Practice Address - Phone:708-799-1780
Practice Address - Fax:708-799-4914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty