Provider Demographics
NPI:1467405670
Name:SHAFRIN, FRED M (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:M
Last Name:SHAFRIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5150 N PORT WASHINGTON RD
Mailing Address - Street 2:#251
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5474
Mailing Address - Country:US
Mailing Address - Phone:414-332-0606
Mailing Address - Fax:414-967-3604
Practice Address - Street 1:5150 N PORT WASHINGTON RD
Practice Address - Street 2:#251
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-5474
Practice Address - Country:US
Practice Address - Phone:414-332-0606
Practice Address - Fax:414-967-3604
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI25030207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30447000Medicaid
WI18001206OtherRAILROAD MEDICARE
WI0245850001OtherDMERC
WIB56525Medicare UPIN