Provider Demographics
NPI:1356335889
Name:SHPILBERG, VICTOR JAMES (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:JAMES
Last Name:SHPILBERG
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 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:8033 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-1344
Practice Address - Country:US
Practice Address - Phone:502-937-3154
Practice Address - Fax:502-935-0743
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201014350Medicaid
KY64270770Medicaid
KY000000674699OtherANTHEM- NORTON MEDICAL ASSOCIATES
KY000057043SOtherHUMANA- NMA
KY50031911OtherPASSPORT ADVANTAGE- NMA
KY117791OtherSIHO- NMA
KY50026733OtherPASSPORT
KY50031911OtherPASSPORT- NMA
KY117791OtherSIHO- NMA
KY0115001Medicare PIN