Basic Information
| Provider Information | |||||||||
| NPI: | 1649278870 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHEKHANI | ||||||||
| FirstName: | SHAHID | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 MINERAL POINT AVE | ||||||||
| Address2: | |||||||||
| City: | JANESVILLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535482940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6087566871 | ||||||||
| FaxNumber: | 6087566501 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 MINERAL POINT AVE | ||||||||
| Address2: | |||||||||
| City: | JANESVILLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535482940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6087566871 | ||||||||
| FaxNumber: | 6087566501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 08/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | 4301064127 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RX0202X | 44136-20 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 000000517515 | 01 | IN | ANTHEM BCBS | OTHER | 4331600 | 05 | MI | MEDICAID | 110270056 | 01 | MI | BCBS | OTHER | 200851920 | 05 | IN | MEDICAID | 34341200 | 05 | WI | MEDICAID | SHEKHSA | 01 | WI | MERCYCARE INSURANCE | OTHER | P00277426 | 01 | MI | RAILROAD MEDICARE | OTHER | P00657878CD3624 | 01 | WI | RR MEDICARE | OTHER |