Provider Demographics
NPI:1730246380
Name:SHAH, ASHOKKUMAR K (MD)
Entity type:Individual
Prefix:
First Name:ASHOKKUMAR
Middle Name:K
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3734 7TH AVE
Mailing Address - Street 2:SUITE 24
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-5525
Mailing Address - Country:US
Mailing Address - Phone:262-654-0487
Mailing Address - Fax:262-654-2434
Practice Address - Street 1:3734 7TH AVE
Practice Address - Street 2:SUITE 24
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-5525
Practice Address - Country:US
Practice Address - Phone:262-654-0487
Practice Address - Fax:262-654-2434
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI333242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31853300Medicaid
WI31853300Medicaid