Provider Demographics
NPI:1063499085
Name:SHARPE, BRYAN M (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:M
Last Name:SHARPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 775985
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5985
Mailing Address - Country:US
Mailing Address - Phone:317-770-6900
Mailing Address - Fax:317-770-6911
Practice Address - Street 1:601A WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1323
Practice Address - Country:US
Practice Address - Phone:317-776-3456
Practice Address - Fax:317-776-3457
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200246090AMedicaid
IN080190160OtherMEDICARE RR
INM400050247Medicare PIN
H02056Medicare UPIN
IN177280NMedicare PIN