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NPI Code Detail

MEDICARE: AMANDA C SHILS P.A.

MEDICARE: AMANDA C SHILS P.A.
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
1363AM0700XMedical Physician Assistant085001947IL
2363A00000XPhysician Assistant085001947IL

General Provider Information

NPI Number : 1740399880
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA C SHILS P.A.
Provider Business Mailing Address
First Line : 1770 E LAKE SHORE DR
Second Line :
City : DECATUR
State : IL
Zip : 62521-3832
Country : US
Telephone Number : 217-464-1470
Fax Number : 217-464-5163
Provider Business Practice Location Address
First Line : 4965 E LOST BRIDGE RD
Second Line :
City : DECATUR
State : IL
Zip : 62521-5139
Country : US
Telephone Number : 217-864-5531
Fax Number : 217-864-2449
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 02/15/2022

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Directions to “ AMANDA C SHILS P.A.” Practice Location

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