Provider Demographics
NPI:1912987751
Name:SHARP, LOUIS J V (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:J
Last Name:SHARP
Suffix:V
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 1:2160 S FIRST AVE
Mailing Address - Street 2:EMS BLDG., ROOM 0263
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-327-2549
Mailing Address - Fax:708-327-2548
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:EMS BLDG., ROOM 0263
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-327-2549
Practice Address - Fax:708-327-2548
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36105634207P00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202523Medicare ID - Type Unspecified
H68090Medicare UPIN