Provider Demographics
NPI:1942251368
Name:SHILYANSKY, JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:SHILYANSKY
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 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-1763
Mailing Address - Fax:319-356-8378
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-1763
Practice Address - Fax:319-356-8378
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI427902086S0120X
IA370452086S0120X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0749655Medicaid
IA29490OtherWELLMARK BCBS
WI34019800Medicaid
IA29490OtherWELLMARK BCBS
WI34019800Medicaid