Organization
SHIRLEY Y GODIWALLA M.D,S.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHIRLEY Y GODIWALLA MD (OWNER)
(262) 695-3050
Entity
Organization
Contact information
Practice address
10625 W NORTH AVE, SUITE 201, WAUWATOSA, WI 53226-2315
(414) 727-1117
(414) 727-1118
Mailing address
W283N3671 YORKSHIRE TRCE, PEWAUKEE, WI 53072-3311
(262) 695-3050
(262) 695-3051
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
26973
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31392600
—
WI
01
—
340012140
RR MEDICARE
—
Enumeration date
05/04/2006
Last updated
06/07/2011
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