Provider Demographics
NPI:1396836144
Name:SHILS, JAY L (PHD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:L
Last Name:SHILS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-0128
Mailing Address - Country:US
Mailing Address - Phone:847-679-6363
Mailing Address - Fax:847-679-0551
Practice Address - Street 1:1653 W CONGRESS PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3833
Practice Address - Country:US
Practice Address - Phone:847-679-6363
Practice Address - Fax:847-679-0551
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist