Provider Demographics
NPI:1265451611
Name:SHARMA, DEV D (MD)
Entity Type:Individual
Prefix:
First Name:DEV
Middle Name:D
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 1:713 E 142ND ST
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-1062
Mailing Address - Country:US
Mailing Address - Phone:708-841-1121
Mailing Address - Fax:708-841-6976
Practice Address - Street 1:713 E 142ND ST
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-1062
Practice Address - Country:US
Practice Address - Phone:708-841-1121
Practice Address - Fax:708-841-6976
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD89444Medicare UPIN