Basic Information
| Provider Information | |||||||||
| NPI: | 1093762213 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHREESHA | ||||||||
| FirstName: | UDAYA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 MINISTRY PKWY | ||||||||
| Address2: | |||||||||
| City: | WESTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544765220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153933000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3400 MINISTRY PKWY | ||||||||
| Address2: | |||||||||
| City: | WESTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544765220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153933000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 06/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 35.125679 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | 61-320 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | 34951 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RC0200X | 036136134 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 036136134 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207R00000X | 34951 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 34951 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0281071 | 05 | IA | MEDICAID |