Provider Demographics
NPI:1366485849
Name:KILGORE, SHANNON MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MICHELLE
Last Name:KILGORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 MIRANDA AVE
Mailing Address - Street 2:MC 127
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1207
Mailing Address - Country:US
Mailing Address - Phone:650-493-5000
Mailing Address - Fax:650-858-3999
Practice Address - Street 1:3801 MIRANDA AVE
Practice Address - Street 2:MC 127
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:650-858-3999
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA676392084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A676390OtherMEDI-CAL PIN
CAH66301Medicare UPIN
CA00A676390Medicare ID - Type Unspecified