Shalom Medical Inc

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

Legal business name

SHALOM MEDICAL INC

Practice address

977 Green Ridge Dr
De Pere, WI 54115-7656

Phone

(718) 530-8357

Fax

(920) 328-9050

NPI assigned

Mar 15, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Adetujni Adejumo

Title

Owner

Phone

(718) 530-8357

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Adetunji A Adejumo, MD

  • Infectious Disease Physician
  • Green Bay, WI
  • NPI 1942532528
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458000000000",
    "number": "1417318635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "977 GREEN RIDGE DR",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541157656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "977 GREEN RIDGE DR",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541157656",
            "telephone_number": "718-530-8357",
            "fax_number": "920-328-9050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHALOM MEDICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-15",
        "last_updated": "2016-03-15",
        "status": "A",
        "authorized_official_last_name": "ADEJUMO",
        "authorized_official_first_name": "ADETUJNI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-530-8357"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Micayla M Selissen, LCSW
• Rita Ann Selke, DO
• Lisa A Senn, MS CCC-SLP
• Serenity Group Home LLC
• Jessica Ellyn Seyler, PT
• Vijayalakshmi Shetty
• Shifting Healthcare, LLC
• Rachel N Shimek, MS, OTR
• Shopko Optical Manufacturing LLC
• Shopko Stores Operating Co LLC (ShopKo Pharmacy 005)

• Infectious Disease Physician in De Pere, WI
• Providers in De Pere, WI by specialty
• Infectious Disease Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.