Healthcare Provider Details

I. General information

NPI: 1114970399
Provider Name (Legal Business Name): SHEKHAR A DAGAM MD NEUROLOGICAL SURGERY SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 W KINNICKINNIC RIVER PKWY #201
MILWAUKEE WI
53215-3677
US

IV. Provider business mailing address

PO BOX 78082
MILWAUKEE WI
53278-0082
US

V. Phone/Fax

Practice location:
  • Phone: 414-385-7150
  • Fax: 414-385-7159
Mailing address:
  • Phone: 414-385-7150
  • Fax: 414-385-7159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number4351420
License Number StateWI

VIII. Authorized Official

Name: DR. SHEKHAR A DAGAM
Title or Position: OWNER
Credential: MD
Phone: 414-385-7150