MEDICARE: FRED M SHAFRIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	25030	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	18001206	OTHER	WI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0245850001	OTHER	WI	DMERC

General Provider Information

NPI Number	:	1467405670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRED M SHAFRIN M.D.

Provider Business Mailing Address
First Line	:	5150 N PORT WASHINGTON RD
Second Line	:	#251
City	:	MILWAUKEE
State	:	WI
Zip	:	53217-5474
Country	:	US
Telephone Number	:	414-332-0606
Fax Number	:	414-967-3604

Provider Business Practice Location Address
First Line	:	5150 N PORT WASHINGTON RD
Second Line	:	#251
City	:	MILWAUKEE
State	:	WI
Zip	:	53217-5474
Country	:	US
Telephone Number	:	414-332-0606
Fax Number	:	414-967-3604

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/08/2007

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Directions to “ FRED M SHAFRIN M.D.” Practice Location

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