Provider Demographics
NPI:1558471151
Name:SHISKO, BILL LOUIS (DO)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:LOUIS
Last Name:SHISKO
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Gender:M
Credentials:DO
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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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MO35717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOD41571Medicare UPIN