Provider Demographics
NPI:1215340161
Name:SHARMA, SAMIR
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 S WABASH AVE
Mailing Address - Street 2:APT. 2507
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2350
Mailing Address - Country:US
Mailing Address - Phone:269-806-8408
Mailing Address - Fax:
Practice Address - Street 1:1111 S WABASH AVE
Practice Address - Street 2:APT. 2507
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2350
Practice Address - Country:US
Practice Address - Phone:269-806-8408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist