Healthcare Provider Details

I. General information

NPI: 1063036762
Provider Name (Legal Business Name): SHASHWAT POKHAREL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date: 01/18/2022
Reactivation Date: 09/29/2022

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-8710
  • Fax: 414-805-1101
Mailing address:
  • Phone: 414-805-8710
  • Fax: 414-805-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number1063036762
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: