1649278870 NPI number — SHAHID SHEKHANI MD

Table of content: SHAHID SHEKHANI MD (NPI 1649278870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649278870 NPI number — SHAHID SHEKHANI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEKHANI
Provider First Name:
SHAHID
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:
1649278870
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 MINERAL POINT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JANESVILLE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53548-2940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-756-6871
Provider Business Mailing Address Fax Number:
608-756-6501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 MINERAL POINT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JANESVILLE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53548-2940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-756-6871
Provider Business Practice Location Address Fax Number:
608-756-6501
Provider Enumeration Date:
07/12/2005

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: 207RX0202X , with the licence number:  4301064127 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X , with the licence number: 44136-20 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000517515 . This is a "ANTHEM BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 4331600 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110270056 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 200851920 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34341200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: SHEKHSA . This is a "MERCYCARE INSURANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: P00277426 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00657878CD3624 . This is a "RR MEDICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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