Provider Demographics
NPI:1629464177
Name:SHEFTIC, ERICK T (MD)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:T
Last Name:SHEFTIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2901 INTERNATIONAL LN STE 100
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3177
Mailing Address - Country:US
Mailing Address - Phone:608-217-3798
Mailing Address - Fax:608-480-8070
Practice Address - Street 1:2901 INTERNATIONAL LN STE 100
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3177
Practice Address - Country:US
Practice Address - Phone:608-217-3798
Practice Address - Fax:608-217-3798
Is Sole Proprietor?:No
Enumeration Date:2015-04-11
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI673632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100047656Medicaid