Individual
KEITH WESTLEY SHILLITO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
905 FIESTA, PARKER, AZ 85344-5152
(928) 669-2225
(928) 669-6751
Mailing address
905 FIESTA, PARKER, AZ 85344-5152
(928) 669-2225
(928) 669-6751
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
32755
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
480046
—
AZ
05
—
862690
—
AZ
05
—
ZP03006701
—
AZ
Enumeration date
06/30/2005
Last updated
02/26/2014
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