1063463131 NPI number — SHARMILA MAKHIJA MD

Table of content: SHARMILA MAKHIJA MD (NPI 1063463131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063463131 NPI number — SHARMILA MAKHIJA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAKHIJA
Provider First Name:
SHARMILA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1063463131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 S JACKSON ST
Provider Second Line Business Mailing Address:
ACB/2ND FLOOR
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202-1622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
529 S. JACKSON STREET 3RD FLOOR
Provider Second Line Business Practice Location Address:
JAMES GRAHAM BROWN CANCER CENTER
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-561-7220
Provider Business Practice Location Address Fax Number:
502-561-7327
Provider Enumeration Date:
05/13/2006

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: 207VX0201X , with the licence number:  24337 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0201X , with the licence number: 29816 , 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: 009975190 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 160054884 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051504895 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051504896 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051530408 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051504895 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009932914 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009969175 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051524138 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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