Provider Demographics
NPI:1164773560
Name:KULBHUSHAN K. SHARMA MD, PC
Entity Type:Organization
Organization Name:KULBHUSHAN K. SHARMA MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PURNIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-330-7465
Mailing Address - Street 1:5620 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE D-2
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4636
Mailing Address - Country:US
Mailing Address - Phone:602-298-9741
Mailing Address - Fax:602-298-9745
Practice Address - Street 1:5620 W THUNDERBIRD RD
Practice Address - Street 2:SUITE D-2
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4636
Practice Address - Country:US
Practice Address - Phone:602-298-9741
Practice Address - Fax:602-298-9745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ222862086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF84622Medicare UPIN