Provider Demographics
NPI:1619054228
Name:SHARMA, REKHA (MD)
Entity Type:Individual
Prefix:MRS
First Name:REKHA
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 1:3330 W 177TH ST
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2184
Mailing Address - Country:US
Mailing Address - Phone:708-799-5455
Mailing Address - Fax:708-799-5736
Practice Address - Street 1:3330 W 177TH ST
Practice Address - Street 2:SUITE 2E
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2184
Practice Address - Country:US
Practice Address - Phone:708-799-5455
Practice Address - Fax:708-799-5736
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-095503207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36095503OtherLICENSE NUMBER
ILF71342Medicare UPIN
IL529710Medicare PIN
ILIL2817001Medicare PIN