Active NPI
Altaf Hussain Shah
- Dentist
- Milwaukee, WI
National Provider Identifier
1790569739
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 82085-875
- Practice address
- 1801 W Wisconsin Ave
Milwaukee, WI 53233-2186 - Phone
- (414) 288-6920
- NPI assigned
- Aug 21, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 82085-875 | WI | Primary |
Addresses
Primary practice location
1801 W Wisconsin Ave
Milwaukee, WI 53233-2186
Mailing address
18270 Taywood Cir
Brookfield, WI 53045-5682
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Sep 28, 2023 through Sep 28, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 82085-875 | WI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692576000000",
"number": "1790569739",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18270 TAYWOOD CIR",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530455682"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 W WISCONSIN AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532332186",
"telephone_number": "414-288-6920"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAH",
"first_name": "ALTAF",
"middle_name": "HUSSAIN",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-08-21",
"last_updated": "2023-08-21",
"certification_date": "2023-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "82085-875",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.