Provider Demographics
NPI:1598995995
Name:SHAIKH, SUMAIRA TALIB (MD)
Entity Type:Individual
Prefix:
First Name:SUMAIRA
Middle Name:TALIB
Last Name:SHAIKH
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 1:903 MINERAL POINT AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2970
Mailing Address - Country:US
Mailing Address - Phone:608-741-3814
Mailing Address - Fax:608-741-3816
Practice Address - Street 1:903 MINERAL POINT AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2970
Practice Address - Country:US
Practice Address - Phone:608-741-3814
Practice Address - Fax:608-741-3816
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI54894-20207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400165796-000054176OtherWI MEDICARE
WI1598995995Medicaid
WISHAIKSUMOtherMERCYCARE INSURANCE
WI1598995995OtherBCBSWI
IL$$$$$$$$$OtherIL IMPACT