Provider Demographics
NPI:1497815757
Name:SHARMA, ANJALI JAIN (MD)
Entity Type:Individual
Prefix:
First Name:ANJALI
Middle Name:JAIN
Last Name:SHARMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANJALI
Other - Middle Name:
Other - Last Name:JAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:MAIL STATION 958
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-7615
Mailing Address - Fax:414-266-6238
Practice Address - Street 1:1215 GEORGE TOWNE DRIVE
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-2731
Practice Address - Country:US
Practice Address - Phone:262-691-3843
Practice Address - Fax:262-691-4287
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49879-020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1497815757Medicaid
WI736011780Medicare PIN