Provider Demographics
NPI:1043499049
Name:SHAD, UMAR (MD)
Entity type:Individual
Prefix:
First Name:UMAR
Middle Name:
Last Name:SHAD
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 1:5800 W BURLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1516
Mailing Address - Country:US
Mailing Address - Phone:414-444-7787
Mailing Address - Fax:414-444-8803
Practice Address - Street 1:5800 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1516
Practice Address - Country:US
Practice Address - Phone:414-444-7787
Practice Address - Fax:414-444-8803
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2015-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52104-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1043499049Medicaid
WIK400175553Medicare PIN