Provider Demographics
NPI:1518929397
Name:SHARMA, SHIV K (MD)
Entity Type:Individual
Prefix:
First Name:SHIV
Middle Name:K
Last Name:SHARMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:722 S DENTON TAP RD STE 190
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4555
Mailing Address - Country:US
Mailing Address - Phone:972-365-6255
Mailing Address - Fax:972-393-1234
Practice Address - Street 1:722 S DENTON TAP RD STE 190
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4555
Practice Address - Country:US
Practice Address - Phone:972-365-6255
Practice Address - Fax:972-393-1234
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6317208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105629301Medicaid
TX314962Medicare PIN
87T724Medicare ID - Type Unspecified
TX105629301Medicaid