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NPI Code Detail

MEDICARE: FARAH SHAUKAT MD

MEDICARE: FARAH SHAUKAT MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician84949-20WI
2390200000XStudent in an Organized Health Care Education/Training Program100037-851WI

General Provider Information

NPI Number : 1124712393
Entity Type Code : Individual
Provider Name (Legal Business Name) : FARAH SHAUKAT MD
Provider Business Mailing Address
First Line : 350 PELLER RD
Second Line :
City : LAKE GENEVA
State : WI
Zip : 53147-4543
Country : US
Telephone Number : 262-249-0221
Fax Number : 262-249-0633
Provider Business Practice Location Address
First Line : 350 PELLER RD
Second Line :
City : LAKE GENEVA
State : WI
Zip : 53147-4543
Country : US
Telephone Number : 262-249-0221
Fax Number : 262-249-0633
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2023
Last Update Date : 05/19/2026

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