Healthcare Provider Details

I. General information

NPI: 1568499002
Provider Name (Legal Business Name): SHARON K. SHEPICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15397 STATE HIGHWAY 32
LAKEWOOD WI
54138-9702
US

IV. Provider business mailing address

PO BOX 179 15397 STATE HWY 32
LAKEWOOD WI
54138-0179
US

V. Phone/Fax

Practice location:
  • Phone: 715-276-6321
  • Fax: 715-276-1428
Mailing address:
  • Phone: 715-276-6321
  • Fax: 715-276-1428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301114255
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39820
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: