Provider Demographics
NPI:1386722817
Name:PRAG, AMI (MD)
Entity type:Individual
Prefix:DR
First Name:AMI
Middle Name:
Last Name:PRAG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMI
Other - Middle Name:
Other - Last Name:PIYUSH PRAGNESH SHAH
Other - Suffix:
Other - Last Name Type:Doing Business As
Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-647-6326
Mailing Address - Fax:
Practice Address - Street 1:5900 S LAKE DRIVE
Practice Address - Street 2:#100
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110
Practice Address - Country:US
Practice Address - Phone:414-489-4190
Practice Address - Fax:414-489-4015
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34578400Medicaid
BS8866975OtherDEA NUMBER
I18496Medicare UPIN