Healthcare Provider Details

I. General information

NPI: 1184808529
Provider Name (Legal Business Name): SUHAIL AHMED SHAIKH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 22ND AVE. MONROE CLINIC
MONROE WI
53566-1569
US

IV. Provider business mailing address

515 22ND AVENUE
MONROE WI
53566-1569
US

V. Phone/Fax

Practice location:
  • Phone: 608-324-2222
  • Fax: 608-755-7873
Mailing address:
  • Phone: 608-755-7960
  • Fax: 608-755-7873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00049089
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number57187-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: