Provider Demographics
NPI:1568753846
Name:SHARMA, NITIN (MD)
Entity Type:Individual
Prefix:
First Name:NITIN
Middle Name:
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 1:1 ERIE CT STE 4030
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2510
Mailing Address - Country:US
Mailing Address - Phone:708-386-7888
Mailing Address - Fax:708-386-2784
Practice Address - Street 1:1 ERIE CT STE 4030
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2510
Practice Address - Country:US
Practice Address - Phone:708-386-7888
Practice Address - Fax:708-386-2784
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130941208800000X
IL036145903208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021180800Medicaid
FLIZ915ZOtherMEDICARE