MEDICARE: JAMAL SHILLINGFORD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0117X	Orthopaedic Surgery of the Spine Physician	51177	KY
2	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063855567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMAL SHILLINGFORD

Provider Business Mailing Address
First Line	:	PO BOX 776351
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6351
Country	:	US
Telephone Number	:	502-272-5063
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 BON AIR RD STE 120
Second Line	:
City	:	LARKSPUR
State	:	CA
Zip	:	94939-1142
Country	:	US
Telephone Number	:	415-927-5300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2013
Last Update Date	:	08/20/2019

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Directions to “ JAMAL SHILLINGFORD ” Practice Location

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