Provider Demographics
NPI:1396711297
Name:MAHATME, SHERAN S (DO)
Entity type:Individual
Prefix:DR
First Name:SHERAN
Middle Name:S
Last Name:MAHATME
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:INFECTIOUS DISEASE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-6444
Mailing Address - Fax:414-805-6702
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:INFECTIOUS DISEASE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-6444
Practice Address - Fax:414-805-6702
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201736207RI0200X, 207R00000X
NC2009-1453207RI0200X
WI65183207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10003501OtherSENTARA / OPTIMA INFECTIOUS DISEASE
VA010188075Medicaid
WI1396711297Medicaid
VAPAROtherCIGNA
VAPAROtherUSA MANAGED CARE
VA-032OtherTRICARE/CHAMPUS
VA186800OtherANTHEM
NC5901553Medicaid
NC154EEOtherBC/BS NC
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherCORVEL/CORCARE
NC01553OtherBC/BS
VAPAROtherMULTIPLAN
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VA10003793OtherSENTARA/INF DIS PCP
VA9140289OtherUHC/MAMSI
VAPAROtherAETNA
VAPAROtherMULTIPLAN
VA186800OtherANTHEM
VAI45441Medicare UPIN
VA010188075Medicaid