MEDICARE: KAHLIL A SHILLINGFORD M.D.

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	208600000X	Surgery Physician	ME0093306	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	I36010	OTHER		UPIN

General Provider Information

NPI Number	:	1366405169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAHLIL A SHILLINGFORD M.D.

Provider Business Mailing Address
First Line	:	9960 CENTRAL PARK BLVD N
Second Line	:	SUITE 235
City	:	BOCA RATON
State	:	FL
Zip	:	33428-1759
Country	:	US
Telephone Number	:	561-483-8840
Fax Number	:	561-483-3342

Provider Business Practice Location Address
First Line	:	9960 CENTRAL PARK BLVD N
Second Line	:	SUITE 235
City	:	BOCA RATON
State	:	FL
Zip	:	33428-1759
Country	:	US
Telephone Number	:	561-483-8840
Fax Number	:	561-483-3342

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	01/03/2011

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Directions to “ KAHLIL A SHILLINGFORD M.D.” Practice Location

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