Basic Information
| Provider Information | |||||||||
| NPI: | 1720167372 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHARMA | ||||||||
| FirstName: | BALJIT | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 848491 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752848491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542029330 | ||||||||
| FaxNumber: | 2542029349 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 HILLCREST MEDICAL BLVD STE 104 | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767128953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542027800 | ||||||||
| FaxNumber: | 2542027856 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 02/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | L7556 | TX | N | Allopathic & Osteopathic Physicians | Surgery | 208G00000X | MD00031714 | WA | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | L7556 | TX | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 0117042 | 01 | WA | L&I | OTHER | 8197030 | 05 | WA | MEDICAID | BS4965781 | 01 | DEA | OTHER |