Provider Demographics
NPI:1871554964
Name:SHLIMAK, ILIA (MD)
Entity type:Individual
Prefix:
First Name:ILIA
Middle Name:
Last Name:SHLIMAK
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 1:321 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3718
Mailing Address - Country:US
Mailing Address - Phone:978-635-8700
Mailing Address - Fax:978-635-8920
Practice Address - Street 1:321 MAIN ST
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3718
Practice Address - Country:US
Practice Address - Phone:978-635-8700
Practice Address - Fax:978-635-8920
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76049207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3138178Medicaid
MAF73922Medicare UPIN
MA3138178Medicaid