Provider Demographics
NPI:1922287168
Name:DEEPAK SHARMA, M.D., LTD.
Entity Type:Organization
Organization Name:DEEPAK SHARMA, M.D., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:RENU
Authorized Official - Middle Name:
Authorized Official - Last Name:KHITRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-853-7777
Mailing Address - Street 1:4275 BURNHAM AVE STE 128
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5400
Mailing Address - Country:US
Mailing Address - Phone:702-853-7777
Mailing Address - Fax:702-853-7770
Practice Address - Street 1:4275 BURNHAM AVE STE 128
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5400
Practice Address - Country:US
Practice Address - Phone:702-853-7777
Practice Address - Fax:702-853-7770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
V100200Medicare PIN
G79604Medicare UPIN