Provider Demographics
NPI:1366544330
Name:SHIVPURI, CHANDRA R (MD)
Entity type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:R
Last Name:SHIVPURI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:7515 N BEACH DR
Mailing Address - Street 2:
Mailing Address - City:FOX POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3665
Mailing Address - Country:US
Mailing Address - Phone:414-228-6502
Mailing Address - Fax:414-228-6502
Practice Address - Street 1:3070 N 51ST ST
Practice Address - Street 2:SUITE 309
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1645
Practice Address - Country:US
Practice Address - Phone:414-447-2674
Practice Address - Fax:414-447-2884
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI254312080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30526900Medicaid
WI30526900Medicaid