Provider Demographics
NPI:1659587244
Name:FEHR, SHAYNE D (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAYNE
Middle Name:D
Last Name:FEHR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3365 S 103RD ST
Mailing Address - Street 2:PEDIATRIC SPORTS MEDICINE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53227-4161
Mailing Address - Country:US
Mailing Address - Phone:414-955-2600
Mailing Address - Fax:414-955-6440
Practice Address - Street 1:3365 S 103RD ST
Practice Address - Street 2:PEDIATRIC SPORTS MEDICINE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-4161
Practice Address - Country:US
Practice Address - Phone:414-955-2600
Practice Address - Fax:414-955-6440
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2012-06-13
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI55847207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1659587244Medicaid
WI680860954Medicare PIN
WI736012189Medicare PIN