Individual
SHAWN C. EKSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
777 ALGOMA BLVD, RADFORD HALL, OSHKOSH, WI 54901-3534
(920) 424-2424
(920) 424-1769
Mailing address
777 ALGOMA BLVD, RADFORD HALL, OSHKOSH, WI 54901-3534
(920) 424-2424
(920) 424-1769
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36923-020
WI
208600000X
Surgery Physician
36923-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
322111700
—
WI
Enumeration date
08/02/2005
Last updated
06/15/2015
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