Provider Demographics
NPI:1093862070
Name:SHARMA MEDICAL CARE CENTERS PC
Entity Type:Organization
Organization Name:SHARMA MEDICAL CARE CENTERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-662-2224
Mailing Address - Street 1:5815 S CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46320-2352
Mailing Address - Country:US
Mailing Address - Phone:219-932-4921
Mailing Address - Fax:219-661-8892
Practice Address - Street 1:5815 S CALUMET AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-2352
Practice Address - Country:US
Practice Address - Phone:219-932-4921
Practice Address - Fax:219-661-8892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031739A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CN9796OtherRAILROAD MEDICARE
IN877510Medicare ID - Type Unspecified
INC25476Medicare UPIN