Provider Demographics
NPI:1669425344
Name:MINHAS-PANNU, SHEEBA A (MD)
Entity type:Individual
Prefix:
First Name:SHEEBA
Middle Name:A
Last Name:MINHAS-PANNU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHEEBA
Other - Middle Name:A
Other - Last Name:MINHAS-PANNU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 241393
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-9032
Mailing Address - Country:US
Mailing Address - Phone:414-732-0790
Mailing Address - Fax:
Practice Address - Street 1:2323 S 102ND ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2103
Practice Address - Country:US
Practice Address - Phone:414-541-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34836000Medicaid
WI34836000Medicaid