Provider Demographics
NPI:1306012075
Name:SHARMA, BHANOO (MD)
Entity Type:Individual
Prefix:DR
First Name:BHANOO
Middle Name:
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 1:17577 KEDZIE AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2051
Mailing Address - Country:US
Mailing Address - Phone:773-359-1275
Mailing Address - Fax:
Practice Address - Street 1:17577 KEDZIE AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2051
Practice Address - Country:US
Practice Address - Phone:773-359-1275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117663208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery