Edward Shackleford, DO
Emergency Medicine in Kenosha, WI. Individual provider (NPI-1).
NPI number1790769800
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1790769800
- Entity type
- Individual (NPI-1)
- Name
- Edward Shackleford
- Credential
- DO
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Dec 1, 2005
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207P00000X | Emergency Medicine | 42953021 | WI | Yes |
Practice location
10400 75th StAurora Medical Center
Kenosha, WI 53142-7884
Phone 262-697-7000 · Fax 630-734-1560
Mailing address
Po Box 3043Mea Aea Kenosh Sc
Oak Brook, IL 60522-3043
Phone 630-734-0200 · Fax 630-734-1560
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