Provider Demographics
NPI:1720167372
Name:SHARMA, BALJIT K (MD)
Entity type:Individual
Prefix:DR
First Name:BALJIT
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:PO BOX 848491
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8491
Mailing Address - Country:US
Mailing Address - Phone:254-202-9330
Mailing Address - Fax:254-202-9349
Practice Address - Street 1:50 HILLCREST MEDICAL BLVD STE 104
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8953
Practice Address - Country:US
Practice Address - Phone:254-202-7800
Practice Address - Fax:254-202-7856
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7556208600000X, 208G00000X
WAMD00031714208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0117042OtherL&I
WA8197030Medicaid
BS4965781OtherDEA
BS4965781OtherDEA
G31638Medicare UPIN