Healthcare Provider Details

I. General information

NPI: 1073801395
Provider Name (Legal Business Name): SHALEM HEALING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3338 N DOCTOR MARTIN LUTHER KING JR. DRIVE
MILWAUKEE WI
53212
US

IV. Provider business mailing address

3338 N DOCTOR MARTIN LUTHER KING JR. DRIVE
MILWAUKEE WI
53212
US

V. Phone/Fax

Practice location:
  • Phone: 414-640-5433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN GELFMAN
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 414-640-5433