Provider Demographics
NPI:1871768051
Name:GHOGHAWALA, SHAHED YUNUS (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHED
Middle Name:YUNUS
Last Name:GHOGHAWALA
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 1:1025 REGENT ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1248
Mailing Address - Country:US
Mailing Address - Phone:608-282-2000
Mailing Address - Fax:608-282-2172
Practice Address - Street 1:1025 REGENT ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1248
Practice Address - Country:US
Practice Address - Phone:608-282-2000
Practice Address - Fax:608-282-2172
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5806207W00000X, 207WX0120X
WI54016207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1871768051Medicaid