Healthcare Provider Details

I. General information

NPI: 1730134669
Provider Name (Legal Business Name): SHEETAL KANDIAH, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 N FARWELL AVE UNIT 403
MILWAUKEE WI
53202-1571
US

IV. Provider business mailing address

1920 N FARWELL AVE UNIT 403
MILWAUKEE WI
53202-1571
US

V. Phone/Fax

Practice location:
  • Phone: 414-763-6023
  • Fax:
Mailing address:
  • Phone: 414-763-6023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SHEETAL KANDIAH
Title or Position: PRESIDENT
Credential: MD
Phone: 414-763-6023