Healthcare Provider Details

I. General information

NPI: 1639299936
Provider Name (Legal Business Name): MICHAEL SELIM SHILLINGFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-8426
US

IV. Provider business mailing address

PO BOX 100297
GAINESVILLE FL
32610-0297
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5422
  • Fax: 352-273-5927
Mailing address:
  • Phone: 352-273-5422
  • Fax: 352-273-5927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME109640
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberA112088
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: