Provider Demographics
NPI:1093856999
Name:SKS PLASTIC SURGERY PA
Entity Type:Organization
Organization Name:SKS PLASTIC SURGERY PA
Other - Org Name:SANJAY K SHARMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-617-7500
Mailing Address - Street 1:4220 BULL CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1602
Mailing Address - Country:US
Mailing Address - Phone:512-617-7500
Mailing Address - Fax:512-323-9382
Practice Address - Street 1:4220 BULL CREEK RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6026
Practice Address - Country:US
Practice Address - Phone:512-617-7500
Practice Address - Fax:512-323-9382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK65032082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0028QDOtherBCBS GROUP NUMBER
TX178419101Medicaid
TX00668ZMedicare PIN