Provider Demographics
NPI:1568499002
Name:SHEPICH, SHARON K (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:K
Last Name:SHEPICH
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:PO BOX 179
Mailing Address - Street 2:15397 STATE HWY 32
Mailing Address - City:LAKEWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:54138-0179
Mailing Address - Country:US
Mailing Address - Phone:715-276-6321
Mailing Address - Fax:715-276-1428
Practice Address - Street 1:15397 STATE HIGHWAY 32
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WI
Practice Address - Zip Code:54138-9702
Practice Address - Country:US
Practice Address - Phone:715-276-6321
Practice Address - Fax:715-276-1428
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301114255208D00000X
WI39820207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ145178Medicaid
WI32598600Medicaid
WI39820OtherWI LICENSE
CO52274080Medicaid
NM81006888Medicaid
AZ145178Medicaid
NM81006888Medicaid
WI32598600Medicaid