Provider Demographics
NPI:1013968395
Name:KAILASH C. SHARMA MD SC
Entity Type:Organization
Organization Name:KAILASH C. SHARMA MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAILASH
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-687-4620
Mailing Address - Street 1:7891 BROADWAY STE A
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5556
Mailing Address - Country:US
Mailing Address - Phone:219-756-3988
Mailing Address - Fax:219-756-2595
Practice Address - Street 1:6360 159TH ST
Practice Address - Street 2:SUITE A B
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-2725
Practice Address - Country:US
Practice Address - Phone:708-687-4620
Practice Address - Fax:708-687-4625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-094003207R00000X, 207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632588OtherBLUE SHIELD PPO #
IL01632588OtherGROUP BLUE SHIELD NUMBER
IL01632588OtherBLUE SHIELD PPO #
IL110241053Medicare PIN
IL01632588OtherGROUP BLUE SHIELD NUMBER
IL5508980001Medicare PIN