Provider Demographics
NPI:1801895743
Name:SHARMA, VENKATA KRISHNA (MD)
Entity type:Individual
Prefix:
First Name:VENKATA
Middle Name:KRISHNA
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 1:3535 30TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144
Mailing Address - Country:US
Mailing Address - Phone:262-652-7813
Mailing Address - Fax:262-652-4450
Practice Address - Street 1:3535 30TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144
Practice Address - Country:US
Practice Address - Phone:262-652-7813
Practice Address - Fax:262-652-4450
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI218462084P0015X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30205800Medicaid
WI30205800Medicaid