Provider Demographics
NPI:1306278023
Name:SHILK, KYLE (DO)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:SHILK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SPORTSMAN DR STE 20
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-8572
Mailing Address - Country:US
Mailing Address - Phone:814-223-9834
Mailing Address - Fax:814-223-9830
Practice Address - Street 1:18 SPORTSMAN DR STE 20
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8572
Practice Address - Country:US
Practice Address - Phone:814-223-9834
Practice Address - Fax:814-223-9830
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS017254207LP2900X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103501182Medicaid