Provider Demographics
NPI:1114970399
Name:SHEKHAR A DAGAM MD NEUROLOGICAL SURGERY SC
Entity Type:Organization
Organization Name:SHEKHAR A DAGAM MD NEUROLOGICAL SURGERY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEKHAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAGAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-385-7150
Mailing Address - Street 1:PO BOX 78082
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53278-0082
Mailing Address - Country:US
Mailing Address - Phone:414-385-7150
Mailing Address - Fax:414-385-7159
Practice Address - Street 1:2901 W KINNICKINNIC RIVER PKWY
Practice Address - Street 2:#201
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3677
Practice Address - Country:US
Practice Address - Phone:414-385-7150
Practice Address - Fax:414-385-7159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4351420207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34412200Medicaid
WI000001634Medicare PIN
WI6031170001Medicare NSC
WI000001635Medicare PIN
G50076Medicare UPIN
WI000001865Medicare PIN