Provider Demographics
NPI:1790749182
Name:SHARLIN, KENNETH S (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:S
Last Name:SHARLIN
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 1:5528 N FARMER BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-5315
Mailing Address - Country:US
Mailing Address - Phone:417-485-4330
Mailing Address - Fax:417-485-4424
Practice Address - Street 1:5528 N FARMER BRANCH RD
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-5315
Practice Address - Country:US
Practice Address - Phone:417-485-4330
Practice Address - Fax:417-485-4424
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000160886207R00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1790749182Medicaid
MO205011711Medicaid
P00270477OtherRR MEDICARE
MO1790749182Medicaid
G77817Medicare UPIN
MOMA1327035Medicare PIN