Provider Demographics
NPI:1770797359
Name:SHARMA, RAJIV KUMAR (MD)
Entity type:Individual
Prefix:
First Name:RAJIV
Middle Name:KUMAR
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 1:1155 S CONGRESS AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5114
Mailing Address - Country:US
Mailing Address - Phone:561-766-1300
Mailing Address - Fax:561-257-3477
Practice Address - Street 1:1900 COLUMBUS AVE BAY REGION
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6831
Practice Address - Country:US
Practice Address - Phone:989-894-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072350A207RG0100X, 207RG0100X
FLME147718207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201152680Medicaid
IN254200004Medicare PIN
NY03218206Medicaid
NYPENDINGMedicare PIN