Shackleford, Edward

Shackleford, Edward is an individual health care provider with primary practice located at 10400 75Th St Aurora Medical Center, Kenosha WI 53142-7884. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Shackleford, Edward can be contacted via phone (262) 697-7000.

Contact Information

Primary practice address
10400 75Th St Aurora Medical Center Kenosha WI 53142-7884
Phone: (262) 697-7000
Fax: (630) 734-1560
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 42953021 Wisconsin

Profile Details

NPI number 1790769800
LBN Legal business name Shackleford, Edward
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 1st, 2005
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790769800 NPPES
Wisconsin MEDICAID 30099700

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