Provider Demographics
NPI:1255632642
Name:SHARP, MICHAEL KURT (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KURT
Last Name:SHARP
Suffix:
Gender:M
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNIVERSITY CIR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-1390
Mailing Address - Country:US
Mailing Address - Phone:309-298-1955
Mailing Address - Fax:
Practice Address - Street 1:MEMORIAL HALL, SECOND FLOOR
Practice Address - Street 2:W MURRAY ST
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455
Practice Address - Country:US
Practice Address - Phone:309-298-1955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.001338237600000X
IL147.001883231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter