Provider Demographics
NPI:1629055769
Name:SHARMA, KIRAN (MD)
Entity Type:Individual
Prefix:
First Name:KIRAN
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:PO BOX 58748
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8748
Mailing Address - Country:US
Mailing Address - Phone:281-338-6509
Mailing Address - Fax:281-332-1482
Practice Address - Street 1:3711 GARTH RD
Practice Address - Street 2:SUITE 308
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3175
Practice Address - Country:US
Practice Address - Phone:281-420-9886
Practice Address - Fax:281-420-9888
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6240207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115976601Medicaid
TX00T18CMedicare PIN
TX115976601Medicaid