Shah, Jesika
Shah, Jesika is an individual health care provider with primary practice located at 6809 122Nd Ave , Kenosha WI 53142-7335. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Shah, Jesika can be contacted via phone (262) 654-8633.Contact Information
Primary practice address
6809 122Nd Ave
Kenosha WI 53142-7335
Phone: (262) 654-8633
Fax: (262) 654-5467
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 70515-20 | Wisconsin |
Profile Details
| NPI number | 1508076555 |
|---|---|
| LBN Legal business name | Shah, Jesika |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 22nd, 2007 |
| Last updated | Jun 12th, 2019 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1508076555 | NPPES |
| Wisconsin | MEDICAID | 1508076555 |
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