Provider Demographics
NPI:1346279940
Name:SHEPHERD, DENNIS W (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:W
Last Name:SHEPHERD
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:W180N8085 TOWN HALL RD
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-3518
Mailing Address - Country:US
Mailing Address - Phone:262-251-1000
Mailing Address - Fax:262-518-5052
Practice Address - Street 1:W180N8085 TOWN HALL RD
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3518
Practice Address - Country:US
Practice Address - Phone:262-251-1000
Practice Address - Fax:262-518-5052
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32377-020207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI930044455OtherMEDICARE RAILROAD
WI31921600Medicaid
WI930068401OtherMEDICARE RAILROAD
WI930075118OtherMEDICARE RAILROAD
WI1346279940Medicaid
3938107579OtherTRICARE NORTH REGION
WI0009-07660Medicare ID - Type Unspecified
WI0022-32280Medicare ID - Type Unspecified
3938107579OtherTRICARE NORTH REGION
WI0021-01400Medicare ID - Type Unspecified
WI31921600Medicaid