Provider Demographics
NPI:1245224773
Name:SHARMA, ANIL K (MD)
Entity Type:Individual
Prefix:
First Name:ANIL
Middle Name:K
Last Name:SHARMA
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 1:100 E LIBERTY ST
Mailing Address - Street 2:STE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-540-3383
Mailing Address - Fax:502-540-3393
Practice Address - Street 1:10300 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-3952
Practice Address - Country:US
Practice Address - Phone:502-995-7775
Practice Address - Fax:502-995-7765
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31733207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64317332Medicaid
KY7100115870Medicaid
KY110146316Medicare PIN
G23704Medicare UPIN
KY7100115870Medicaid
KY1007304Medicare PIN
KYP00823773Medicare PIN