Provider Demographics
NPI:1649364290
Name:SHILS, PHILIPPE N (PA)
Entity type:Individual
Prefix:
First Name:PHILIPPE
Middle Name:N
Last Name:SHILS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 E LAKE SHORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3810
Mailing Address - Country:US
Mailing Address - Phone:217-464-1157
Mailing Address - Fax:217-464-1169
Practice Address - Street 1:1800 E LAKE SHORE DRIVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3810
Practice Address - Country:US
Practice Address - Phone:217-464-1157
Practice Address - Fax:217-464-1169
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001836363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208352Medicare PIN
ILP78202Medicare UPIN
ILK25505Medicare PIN