Provider Demographics
NPI:1477507291
Name:SHARMA, BANSI D (MD)
Entity Type:Individual
Prefix:DR
First Name:BANSI
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 1:17577 SOUTH KEDZIE AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429
Mailing Address - Country:US
Mailing Address - Phone:708-799-1780
Mailing Address - Fax:708-957-5150
Practice Address - Street 1:17577 SOUTH KEDZIE AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429
Practice Address - Country:US
Practice Address - Phone:708-799-1780
Practice Address - Fax:708-957-5150
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051949207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036051949Medicaid
IL036051949Medicaid
IL486830Medicare ID - Type Unspecified