Provider Demographics
NPI:1437427762
Name:WILLIAM L SHISKO,D.O., P.C.
Entity Type:Organization
Organization Name:WILLIAM L SHISKO,D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHISKO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:314-423-4070
Mailing Address - Street 1:9628 MIDLAND BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-3353
Mailing Address - Country:US
Mailing Address - Phone:314-423-4070
Mailing Address - Fax:314-423-2909
Practice Address - Street 1:9628 MIDLAND BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-3353
Practice Address - Country:US
Practice Address - Phone:314-423-4070
Practice Address - Fax:314-423-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO35717208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOD4157Medicare UPIN