JESIKA SHAH (NPI# 1508076555) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508076555 |
| Entity Type | Individual |
| Full Name | JESIKA SHAH |
| Credential | MD |
| Practice Address |
6809 122nd Ave Kenosha WI 53142-7335 |
| Mailing Address |
9000 W Wisconsin Ave # Ms 958 Milwaukee WI 53226-4874 |
| Practice Telephone | 2626548633 |
| Practice Fax Number | 2626545467 |
| Mailing Telephone | 4142667915 |
| Mailing Fax Number | 4142666238 |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2019-06-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 70515-20 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 1508076555 | 05 |
| Street Address |
6809 122ND AVE |
| City | KENOSHA |
| State | WI |
| Zip Code | 53142-7335 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326033671 | Jaya V Iyer | Pediatrics | 6809 122nd Ave, Kenosha, WI 53142-7335 | 2005-09-13 |
| 1043833270 | Linda Flahive | Counselor | 6809 122nd Ave, Kenosha, WI 53142-7335 | 2020-05-21 |
| 1912496290 | Alison D Fritschler | Nurse Practitioner | 6809 122nd Ave, Kenosha, WI 53142-7335 | 2018-05-02 |
| 1295146330 | Anne Elizabeth Hysaw | Social Worker | 6809 122nd Ave, Kenosha, WI 53142-7335 | 2014-05-12 |
| 1740455096 | Children's Medical Group | Pediatrics | 6809 122nd Ave, Kenosha, WI 53142-7335 | 2008-04-28 |
| 1861611980 | Gretchen Lee Huletz | Counselor | 6809 122nd Ave, Kenosha, WI 53142-7335 | 2007-04-25 |
| 1750462602 | Rita R Ventura | Nurse Practitioner | 6809 122nd Ave, Kenosha, WI 53142-7335 | 2006-10-18 |
| 1508973603 | Zaigham U Tahir | Pediatrics | 6809 122nd Ave, Kenosha, WI 53142-7335 | 2006-08-24 |
| 1497771497 | Mickey Kucak | Social Worker | 6809 122nd Ave, Kenosha, WI 53142-7335 | 2006-07-14 |
| 1699715888 | Larry Davis | Pediatrics | 6809 122nd Ave, Kenosha, WI 53142-7335 | 2006-06-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588297816 | Caring Hearts Home Health Care | In Home Supportive Care | 6021-57th Ave, Suite C103, Kenosha, WI 53142 | 2020-02-14 |
| 1144785395 | Michael L Wrzesinski | Counselor | 4109 67th Street, Kenosha, WI 53142 | 2019-02-01 |
| 1720538499 | David Smith | Counselor | 10900 67th Street, Kenosha, WI 53142 | 2016-10-06 |
| 1326404641 | Smile Doctors Ltd | Dentist | 7003 39th Ave, Kenosha, WI 53142 | 2016-01-04 |
| 1225409485 | Antonia Marie Decker | Physician Assistant | 10400 75th St. Ste 204, Kenosha, WI 53142 | 2015-10-14 |
| 1780060582 | Joshua Haas | Pharmacist | 7701 Green Bay Road, Kenosha, IL 53142 | 2015-08-04 |
| 1811379225 | Dana Mary Stout | Registered Nurse | 7401 104th Avenue, Suite 110, Comprehensive Orthopaedics, S.c., Kenosha, WI 53142 | 2015-06-22 |
| 1669815569 | Joshua Knute Elson | Radiology | 6811 118th Ave, Kenosha, WI 53142 | 2013-04-10 |
| 1356610166 | Michael J Gallo | Pharmacist | 7535 North Greenbay Rd, Kenosha, WI 53142 | 2011-12-22 |
| 1720357999 | Orest Carnevale | Registered Nurse | 7316 155th Ct, Kenosha, WI 53142 | 2011-12-18 |
| Find all providers in zip 53142 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780155275 | Children's Health System, Inc. | Pediatrics | 6809 122nd Avenue, Kenosha, WI 54342-7335 | 2018-12-10 |
| 1992125041 | Landon Blair Krantz | Pediatrics | 8600 75th St Ste 101, Kenosha, WI 53142-8200 | 2014-04-16 |
| 1326033671 | Jaya V Iyer | Pediatrics | 6809 122nd Ave, Kenosha, WI 53142-7335 | 2005-09-13 |
| 1174527550 | Sheryn Abraham | Pediatrics | 8600 75th St, Ste 101, Kenosha, WI 53142-8200 | 2005-06-13 |
| 1649519299 | Children's Hospital of Wisconsin | Pediatrics | 8500 75th St, Kenosha, WI 53142-8213 | 2013-02-01 |
| 1952567547 | Umair Sharih | Pediatrics | 4536 22nd Ave, Kenosha, WI 53140-5917 | 2008-08-03 |
| 1740455096 | Children's Medical Group | Pediatrics | 6809 122nd Ave, Kenosha, WI 53142-7335 | 2008-04-28 |
| 1427223783 | Children's Medical Group | Pediatrics | 8600 75th St, Suite 101, Kenosha, WI 53142-8200 | 2008-04-28 |
| 1649397498 | Jennifer Margaret Nelson | Pediatrics | 10400 75th St, Pediatrics, Kenosha, WI 53142-7884 | 2007-03-26 |
| 1295876647 | Frank Serrecchia | Pediatrics | 6125 Green Bay Rd, Suite 700, Kenosha, WI 53142-2928 | 2007-02-09 |
| Find all providers in KENOSHA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.