Provider Demographics
NPI:1275585028
Name:SHANKAR, HARIHARAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HARIHARAN
Middle Name:
Last Name:SHANKAR
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 1:959 N MAYFAIR RD
Mailing Address - Street 2:MCW PAIN MANAGEMENT CENTER
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3465
Mailing Address - Country:US
Mailing Address - Phone:414-955-7601
Mailing Address - Fax:414-955-6020
Practice Address - Street 1:959 N MAYFAIR RD
Practice Address - Street 2:MCW PAIN MANAGEMENT CENTER
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3465
Practice Address - Country:US
Practice Address - Phone:414-955-7601
Practice Address - Fax:414-955-6020
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44813207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1275585028Medicaid
I41488Medicare UPIN
WI061S73601Medicare PIN