Provider Demographics
NPI:1487881108
Name:SHAH, ATIT (MD)
Entity type:Individual
Prefix:
First Name:ATIT
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 KOHLER MEMORIAL DR STE 110
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3174
Mailing Address - Country:US
Mailing Address - Phone:920-204-6758
Mailing Address - Fax:888-720-0495
Practice Address - Street 1:2124 KOHLER MEMORIAL DR STE 110
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3174
Practice Address - Country:US
Practice Address - Phone:920-204-6758
Practice Address - Fax:888-720-0495
Is Sole Proprietor?:No
Enumeration Date:2009-06-20
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI62091207L00000X
IL125.055819207R00000X
WI62091-20208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine