Healthcare Provider Details

I. General information

NPI: 1053408203
Provider Name (Legal Business Name): SHAFI MEDICAL CENTER SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 W NORTH AVE #200
MILWAUKEE WI
53205
US

IV. Provider business mailing address

4555 W SCHROEDER DR #170
MILWAUKEE WI
53223-1475
US

V. Phone/Fax

Practice location:
  • Phone: 414-387-1000
  • Fax: 414-287-1010
Mailing address:
  • Phone: 414-365-3210
  • Fax: 414-365-3225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMAD SHAFI
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 414-287-1000