Provider Demographics
NPI:1164561247
Name:SHAKER, JOSEPH L (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:SHAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W129N7055 NORTHFIELD DR
Mailing Address - Street 2:COMMUNITY MEMORIAL MEDICAL COMMONS
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-0538
Mailing Address - Country:US
Mailing Address - Phone:262-253-2510
Mailing Address - Fax:262-253-3399
Practice Address - Street 1:W129N7055 NORTHFIELD DR
Practice Address - Street 2:COMMUNITY MEMORIAL MEDICAL COMMONS
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-0538
Practice Address - Country:US
Practice Address - Phone:262-253-2510
Practice Address - Fax:262-253-3399
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM9870207RE0101X
WI28432207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1164561247Medicaid
WI736011492Medicare PIN
WI680860407Medicare PIN
WIB56533Medicare UPIN