Provider Demographics
NPI:1629173026
Name:JAMES M SHIRILLA MD PC
Entity Type:Organization
Organization Name:JAMES M SHIRILLA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:NICKLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-354-0845
Mailing Address - Street 1:109 W FLETCHER ST
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-2301
Mailing Address - Country:US
Mailing Address - Phone:989-354-0845
Mailing Address - Fax:989-354-2965
Practice Address - Street 1:405 N DIVISION RD
Practice Address - Street 2:SUITE 3
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9045
Practice Address - Country:US
Practice Address - Phone:231-487-3980
Practice Address - Fax:231-439-0278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJS036674207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1102428731OtherBLUE SHIELD
MI4177153Medicaid
MI1102428731OtherBLUE SHIELD
MI4177153Medicaid