Provider Demographics
NPI:1619125572
Name:SHEA, PATRICK M (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:M
Last Name:SHEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 W KINNICKINNIC RIVER PKWY STE 315
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3660
Mailing Address - Country:US
Mailing Address - Phone:414-385-4638
Mailing Address - Fax:414-649-6282
Practice Address - Street 1:2901 W KINNICKINNIC RIVER PKWY STE 315
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3660
Practice Address - Country:US
Practice Address - Phone:414-385-4638
Practice Address - Fax:414-649-6282
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN57090207L00000X
MN106959207L00000X
IL036130590207L00000X
WI64954207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN050002746Medicare UPIN