Provider Demographics
NPI:1639299936
Name:SHILLINGFORD, MICHAEL SELIM (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SELIM
Last Name:SHILLINGFORD
Suffix:
Gender:M
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:PO BOX 44047
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4047
Mailing Address - Country:US
Mailing Address - Phone:904-376-4083
Mailing Address - Fax:904-391-5075
Practice Address - Street 1:807 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8426
Practice Address - Country:US
Practice Address - Phone:904-202-8290
Practice Address - Fax:904-202-8171
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112088208G00000X
FLME109640208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003630900Medicaid
FL003630900Medicaid