Healthcare Provider Details

I. General information

NPI: 1609028679
Provider Name (Legal Business Name): LANCE A SHILLIAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 01/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W EXCHANGE ST STE 220
AKRON OH
44302-1726
US

IV. Provider business mailing address

224 W EXCHANGE ST SUITE 220
AKRON OH
44302-1704
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-6401
  • Fax: 330-344-1714
Mailing address:
  • Phone: 330-344-6401
  • Fax: 330-344-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.098023
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: