Provider Demographics
NPI:1336313857
Name:SHARMA, PRANEET KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:PRANEET
Middle Name:KUMAR
Last Name:SHARMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6402 E SUPERSTITION SPRINGS BLVD STE 224
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4394
Mailing Address - Country:US
Mailing Address - Phone:480-835-6100
Mailing Address - Fax:480-461-4261
Practice Address - Street 1:6750 E BAYWOOD AVE # 301
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1749
Practice Address - Country:US
Practice Address - Phone:480-835-6100
Practice Address - Fax:480-461-4243
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.012761207RC0000X, 207R00000X
MO2013011939207RC0000X
AZ50410207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ019993Medicaid
AZ019993Medicaid