Provider Demographics
NPI:1487962197
Name:SHILLINGSTAD, ROBERT BRET (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRET
Last Name:SHILLINGSTAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6227 PURCELL RD
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-1753
Mailing Address - Country:US
Mailing Address - Phone:608-835-3710
Mailing Address - Fax:
Practice Address - Street 1:6227 PURCELL RD
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:WI
Practice Address - Zip Code:53575-1753
Practice Address - Country:US
Practice Address - Phone:608-835-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMO00040567208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery