Provider Demographics
NPI:1376523589
Name:SHLIMOVITZ, CARY L (MD)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:L
Last Name:SHLIMOVITZ
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 1:700 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1849
Mailing Address - Country:US
Mailing Address - Phone:608-251-6100
Mailing Address - Fax:608-826-2710
Practice Address - Street 1:700 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1849
Practice Address - Country:US
Practice Address - Phone:608-251-6100
Practice Address - Fax:608-826-2710
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI414702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34518000Medicaid
H92170Medicare UPIN
003315045Medicare ID - Type Unspecified
002754365Medicare ID - Type Unspecified
WI34518000Medicaid