Provider Demographics
NPI:1740265974
Name:SHARMA, SUDARSHAN K (MD)
Entity type:Individual
Prefix:
First Name:SUDARSHAN
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 1:121 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3703
Mailing Address - Country:US
Mailing Address - Phone:630-856-6757
Mailing Address - Fax:630-887-1668
Practice Address - Street 1:121 N ELM ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3703
Practice Address - Country:US
Practice Address - Phone:630-856-6757
Practice Address - Fax:630-887-1668
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36054912207VG0400X
IL036054912207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036054912Medicaid
D14867Medicare UPIN