Provider Demographics
NPI:1629020946
Name:DAGAM, SHEKHAR A (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEKHAR
Middle Name:A
Last Name:DAGAM
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 1:2801 W KINNICKINNIC RIVER PARKWAY
Mailing Address - Street 2:SUITE 550
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215
Mailing Address - Country:US
Mailing Address - Phone:414-385-7150
Mailing Address - Fax:414-385-7159
Practice Address - Street 1:2801 W KINNICKINNIC RIVER PARKWAY
Practice Address - Street 2:SUITE 550
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215
Practice Address - Country:US
Practice Address - Phone:414-385-7150
Practice Address - Fax:414-385-7159
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43514-020207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34412200Medicaid
WI000101635Medicare PIN
WI000201865Medicare PIN
WIG50076Medicare UPIN
WI000101634Medicare PIN
G50076Medicare UPIN
WI34412200Medicaid