Provider Demographics
NPI:1659876910
Name:SHARLIN, PRUTHVI (MD)
Entity Type:Individual
Prefix:
First Name:PRUTHVI
Middle Name:
Last Name:SHARLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PRUTHVI
Other - Middle Name:
Other - Last Name:KOTHARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:303 E ARMY TRAIL RD STE 200
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2143
Practice Address - Country:US
Practice Address - Phone:630-351-2030
Practice Address - Fax:630-351-3983
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-159490207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036159490001Medicaid