Provider Demographics
NPI:1619282225
Name:SHARMA, VIKAS (MBBS)
Entity Type:Individual
Prefix:
First Name:VIKAS
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 S 900 E
Mailing Address - Street 2:SUITE 308
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1893
Mailing Address - Country:US
Mailing Address - Phone:507-319-8829
Mailing Address - Fax:
Practice Address - Street 1:30 N 1900 E
Practice Address - Street 2:SOM 3C-127
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0002
Practice Address - Country:US
Practice Address - Phone:507-319-8829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9384970-1205390200000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN780000171Medicare PIN