1912943218 NPI number — MANISH SHARMA MD

Table of content: MANISH SHARMA MD (NPI 1912943218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912943218 NPI number — MANISH SHARMA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHARMA
Provider First Name:
MANISH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912943218
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776351
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-6351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-588-9490
Provider Business Mailing Address Fax Number:
502-272-5116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 AUDUBON PLAZA DR
Provider Second Line Business Practice Location Address:
SUITE 550
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40217-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-634-3805
Provider Business Practice Location Address Fax Number:
502-634-9336
Provider Enumeration Date:
06/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  966206 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 33322 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 125214 . This is a "SIHO - NBHS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 4310254 . This is a "CIGNA - NBHS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200256270 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6433322 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00933113 . This is a "MEDICARE RAILROAD KY - NBHS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000709340 . This is a "ANTHEM - NBHS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64333222 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50032635 . This is a "PASSPORT - NBHS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000057119R . This is a "HUMANA - NBHS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 015848300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".