Provider Demographics
NPI:1194761940
Name:SCHILLIO, SERGE P (MD)
Entity type:Individual
Prefix:DR
First Name:SERGE
Middle Name:P
Last Name:SCHILLIO
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 1:2500 NILES ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ST JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085
Mailing Address - Country:US
Mailing Address - Phone:269-429-5000
Mailing Address - Fax:269-429-2598
Practice Address - Street 1:2500 NILES ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:ST JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085
Practice Address - Country:US
Practice Address - Phone:269-429-5000
Practice Address - Fax:269-429-2598
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISS051134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E90917Medicare UPIN
N75800001Medicare ID - Type Unspecified