Provider Demographics
NPI:1427073303
Name:GAGRAT, SHOBHA D (MD)
Entity type:Individual
Prefix:
First Name:SHOBHA
Middle Name:D
Last Name:GAGRAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 E WISCONSIN AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4230
Mailing Address - Country:US
Mailing Address - Phone:424-224-3737
Mailing Address - Fax:414-224-3725
Practice Address - Street 1:229 E WISCONSIN AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4230
Practice Address - Country:US
Practice Address - Phone:424-224-3737
Practice Address - Fax:414-224-3725
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21131-0202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30238000Medicaid
WI30238000Medicaid
WI000884911Medicare PIN