Provider Demographics
NPI:1508991050
Name:GAIKWAD, SHILPA JAGDISH (MD)
Entity Type:Individual
Prefix:DR
First Name:SHILPA
Middle Name:JAGDISH
Last Name:GAIKWAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32585 GOLDEN LANTERN, STE E
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3252
Mailing Address - Country:US
Mailing Address - Phone:949-240-2555
Mailing Address - Fax:949-240-2121
Practice Address - Street 1:32585 GOLDEN LANTERN, STE E
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3252
Practice Address - Country:US
Practice Address - Phone:949-240-2555
Practice Address - Fax:949-240-2121
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFK293ZMedicare PIN
CAFK293ZMedicare PIN
CAA66755OtherCA MEDICAL LICENSE NO.
CAW17275OtherMEDICARE GROUP NUMBER
CAH15788Medicare UPIN
CAWA66755BMedicare PIN