Provider Demographics
NPI:1417123696
Name:SHARMA, ANSHU (MD)
Entity Type:Individual
Prefix:
First Name:ANSHU
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12000 ELM CREEK BLVD N
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7073
Mailing Address - Country:US
Mailing Address - Phone:763-235-5100
Mailing Address - Fax:763-420-6698
Practice Address - Street 1:12000 ELM CREEK BLVD N
Practice Address - Street 2:SUITE 130
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7073
Practice Address - Country:US
Practice Address - Phone:763-235-5100
Practice Address - Fax:763-420-6698
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN53186207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1417123696Medicaid
MN080020207Medicare PIN