Basic Information
| Provider Information | |||||||||
| NPI: | 1811976558 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEPPARD | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 E DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | FOND DU LAC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549354560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9209268340 | ||||||||
| FaxNumber: | 9209268370 | ||||||||
| Practice Location | |||||||||
| Address1: | 835 PARKSIDE ST | ||||||||
| Address2: | |||||||||
| City: | RIPON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549718505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9207453530 | ||||||||
| FaxNumber: | 9207457932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2006 | ||||||||
| LastUpdateDate: | 02/16/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | OS005487L | PA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 60816 | WI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 01613901 | 01 | PA | CAPITAL BC / KEYSTONE | OTHER | SH134346 | 01 | PA | PA BLUE SHIELD | OTHER | 112338206 | 05 | PA | MEDICAID | 1518769 | 01 | PA | GATEWAY | OTHER |