Provider Demographics
NPI:1437265394
Name:SHUKLA, SANJEEV N (MD, FAAP)
Entity Type:Individual
Prefix:
First Name:SANJEEV
Middle Name:N
Last Name:SHUKLA
Suffix:
Gender:M
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 SOUTH 27TH STREET
Mailing Address - Street 2:3RD FLOOR - MOB
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-7209
Mailing Address - Country:US
Mailing Address - Phone:414-325-4920
Mailing Address - Fax:414-325-4921
Practice Address - Street 1:10101 SOUTH 27TH STREET
Practice Address - Street 2:3RD FLOOR - MOB
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-7209
Practice Address - Country:US
Practice Address - Phone:414-325-4920
Practice Address - Fax:414-325-4921
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32516208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31750200Medicaid
WIE90260Medicare UPIN
WI02445Medicare ID - Type Unspecified