| Shalom Medical Inc | |
|
977 Green Ridge Dr De Pere WI 54115-7656 | |
| (718) 530-8357 | |
| (920) 328-9050 |
| Full Name | Shalom Medical Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 977 Green Ridge Dr, De Pere, Wisconsin |
| Authorized Official Name and Position | Adetujni Adejumo (OWNER) |
| Authorized Official Contact | 7185308357 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shalom Medical Inc 977 Green Ridge Dr De Pere WI 54115-7656 Ph: () - | Shalom Medical Inc 977 Green Ridge Dr De Pere WI 54115-7656 Ph: (718) 530-8357 |
| NPI Number | 1417318635 |
|---|---|
| Provider Enumeration Date | 03/15/2016 |
| Last Update Date | 03/15/2016 |
| Medicare PECOS PAC ID | 2466759279 |
|---|---|
| Medicare Enrollment ID | O20160322001861 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417318635 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Adetunji A Adejumo |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1942532528 PECOS PAC ID: 9638294986 Enrollment ID: I20100910000295 |
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