Healthcare Provider Details

I. General information

NPI: 1982960563
Provider Name (Legal Business Name): SHIBANI DOGRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2012
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 W KINNICKINNIC RIVER PKWY STE 305
MILWAUKEE WI
53215
US

IV. Provider business mailing address

2901 W KINNICKINNIC RIVER PKWY STE 305
MILWAUKEE WI
53215-3660
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-6000
  • Fax: 414-649-5296
Mailing address:
  • Phone: 414-649-6000
  • Fax: 414-649-5296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number62078-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number62078
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: