MEDICARE: SHIRLEY Y GODIWALLA M.D,S.C

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
1	208800000X	Urology Physician	26973	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	340012140	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760430698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIRLEY Y GODIWALLA M.D,S.C

Provider Business Mailing Address
First Line	:	W283N3671 YORKSHIRE TRCE
Second Line	:
City	:	PEWAUKEE
State	:	WI
Zip	:	53072-3311
Country	:	US
Telephone Number	:	262-695-3050
Fax Number	:	262-695-3051

Provider Business Practice Location Address
First Line	:	10625 W NORTH AVE
Second Line	:	SUITE 201
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-2315
Country	:	US
Telephone Number	:	414-727-1117
Fax Number	:	414-727-1118

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHIRLEY Y GODIWALLA
Credential	:	MD
Telephone Number	:	262-695-3050

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	06/07/2011

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Directions to “SHIRLEY Y GODIWALLA M.D,S.C ” Practice Location

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