Provider Demographics
NPI:1063597540
Name:GRAEWIN, SHANNON J (MD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:J
Last Name:GRAEWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5150 N PORT WASHINGTON ROAD
Mailing Address - Street 2:SUITE 151
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5453
Mailing Address - Country:US
Mailing Address - Phone:414-332-1000
Mailing Address - Fax:414-332-1005
Practice Address - Street 1:5150 N PORT WASHINGTON ROAD
Practice Address - Street 2:SUITE 151
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-5453
Practice Address - Country:US
Practice Address - Phone:414-332-1000
Practice Address - Fax:414-332-1005
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI45794-020208600000X
WI45794208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery