MEDICARE: MARK J. SCHILLER, M.D., PROFESSIONAL CORPORATION

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	2084P0800X	Psychiatry Physician	G76519	CA

General Provider Information

NPI Number	:	1952703456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK J. SCHILLER, M.D., PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	150 NELLEN AVE
Second Line	:	STE. 100
City	:	CORTE MADERA
State	:	CA
Zip	:	94925-1104
Country	:	US
Telephone Number	:	415-945-9870
Fax Number	:	415-945-9325

Provider Business Practice Location Address
First Line	:	150 NELLEN AVE
Second Line	:	STE. 100
City	:	CORTE MADERA
State	:	CA
Zip	:	94925-1104
Country	:	US
Telephone Number	:	415-945-9870
Fax Number	:	415-945-9325

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MARK J. SCHILLER
Credential	:	M.D.
Telephone Number	:	415-945-9870

Provider Enumeration Date	:	09/16/2014
Last Update Date	:	09/16/2014

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