Provider Demographics
NPI:1366405169
Name:SHILLINGFORD, KAHLIL A (MD)
Entity type:Individual
Prefix:
First Name:KAHLIL
Middle Name:A
Last Name:SHILLINGFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9960 CENTRAL PARK BLVD N
Mailing Address - Street 2:SUITE 235
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1759
Mailing Address - Country:US
Mailing Address - Phone:561-483-8840
Mailing Address - Fax:561-483-3342
Practice Address - Street 1:9960 CENTRAL PARK BLVD N
Practice Address - Street 2:SUITE 235
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1759
Practice Address - Country:US
Practice Address - Phone:561-483-8840
Practice Address - Fax:561-483-3342
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0093306208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I36010OtherUPIN