Provider Demographics
NPI:1669564308
Name:SHARMA, KULBHUSHAN K (MD)
Entity type:Individual
Prefix:DR
First Name:KULBHUSHAN
Middle Name:K
Last Name:SHARMA
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 1:5620 W. THUNDERBIRD RD,
Mailing Address - Street 2:D-2
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306
Mailing Address - Country:US
Mailing Address - Phone:602-547-2690
Mailing Address - Fax:602-547-2623
Practice Address - Street 1:5620 W. THUNDERBIRD RD,
Practice Address - Street 2:D-2
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306
Practice Address - Country:US
Practice Address - Phone:602-547-2690
Practice Address - Fax:602-547-2623
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22286208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ313726Medicaid
AZZ21936Medicare ID - Type UnspecifiedPROVIDER NUMBER
AZ313726Medicaid