Basic Information
| Provider Information | |||||||||
| NPI: | 1184808529 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAIKH | ||||||||
| FirstName: | SUHAIL | ||||||||
| MiddleName: | AHMED | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 22ND AVENUE | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535661569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6087557960 | ||||||||
| FaxNumber: | 6087557873 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 22ND AVE. | ||||||||
| Address2: | MONROE CLINIC | ||||||||
| City: | MONROE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535661569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083242222 | ||||||||
| FaxNumber: | 6087557873 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2007 | ||||||||
| LastUpdateDate: | 04/20/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | MD00049089 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 57187-20 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | SHAIKSUH | 01 | WI | MERCYCARE INSURANCE | OTHER | 1184808529 | 05 | WI | MEDICAID |