Provider Demographics
NPI:1346220282
Name:SHAW, KEITH ALAN (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ALAN
Last Name:SHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1515 DELHI ST
Mailing Address - Street 2:STE 200
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6314
Mailing Address - Country:US
Mailing Address - Phone:563-557-7000
Mailing Address - Fax:563-589-4050
Practice Address - Street 1:1515 DELHI ST
Practice Address - Street 2:STE 200
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6314
Practice Address - Country:US
Practice Address - Phone:563-557-7000
Practice Address - Fax:563-589-4050
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA22393208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30508300Medicaid
IA0184580Medicaid
A01828Medicare UPIN
WI30508300Medicaid