Healthcare Provider Details

I. General information

NPI: 1306278023
Provider Name (Legal Business Name): KYLE SHILK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INNOVATION DR STE 104
SLIPPERY ROCK PA
16057-2468
US

IV. Provider business mailing address

7500 BROOKTREE RD STE 302
WEXFORD PA
15090-9285
US

V. Phone/Fax

Practice location:
  • Phone: 866-874-7483
  • Fax: 412-367-7079
Mailing address:
  • Phone: 866-874-7483
  • Fax: 412-367-7079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberOS017254
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: