Provider Demographics
NPI:1366683419
Name:SHETH, ANUJA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANUJA
Middle Name:M
Last Name:SHETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 W VILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-4345
Mailing Address - Country:US
Mailing Address - Phone:414-438-6666
Mailing Address - Fax:414-438-6667
Practice Address - Street 1:5300 W VILLARD AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-4345
Practice Address - Country:US
Practice Address - Phone:414-438-6666
Practice Address - Fax:414-438-6667
Is Sole Proprietor?:No
Enumeration Date:2009-03-19
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52774207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI52774-20OtherWISCONSIN STATE LICENSE
MI4301088161OtherMICHIGAN LICENSE