Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Edward Shackleford, DO

Individual provider Emergency Medicine Physician · NPI 1790769800

Edward Shackleford, DO is an Emergency Medicine Physician in Kenosha, Wisconsin. Licensed in Wisconsin. Registered with an NPI since 2005.

Licensed in
WI
In the registry since
2005
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

10400 75th St Aurora Medical Ctr
Kenosha, WI 53142-7884
Phone: (262) 697-7000
Fax: (630) 734-1560
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Emergency Medicine Physician (primary) Taxonomy 207P00000X · Licence 42953021 (WI)

Record details

NPI number1790769800
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedDecember 1, 2005
Last updated in NPPESJuly 8, 2007
Mailing addressPo Box 3043, Mea Aea Kenosh Sc, Oak Brook, IL 60522-3043

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