Provider Demographics
NPI:1407855083
Name:SHARMA, KAILASH C (MD)
Entity Type:Individual
Prefix:DR
First Name:KAILASH
Middle Name:C
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 1:6360 159TH ST STE A-B
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-2725
Mailing Address - Country:US
Mailing Address - Phone:708-687-4620
Mailing Address - Fax:708-687-4625
Practice Address - Street 1:6360 159TH ST
Practice Address - Street 2:SUITE A-B
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-2725
Practice Address - Country:US
Practice Address - Phone:708-687-4620
Practice Address - Fax:708-687-4625
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094003207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094003Medicaid
ILK27676Medicare PIN
IL036094003Medicaid
ILG45410Medicare UPIN