Provider Demographics
NPI:1023099306
Name:SHALINI, KSHAMATA (MD)
Entity type:Individual
Prefix:DR
First Name:KSHAMATA
Middle Name:
Last Name:SHALINI
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 1:3400 MINISTRY PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-5220
Mailing Address - Country:US
Mailing Address - Phone:715-393-1000
Mailing Address - Fax:715-393-1469
Practice Address - Street 1:3400 MINISTRY PKWY
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-5220
Practice Address - Country:US
Practice Address - Phone:715-393-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA04S962207R00000X
WI40875-20207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40875-20OtherWI STATE LIC
WI32592000Medicaid
WI32592000Medicaid
H01387Medicare UPIN
0012Medicare ID - Type Unspecified