1336209329 NPI number — KRISTIN STAHL MD PC

Table of content: (NPI 1336209329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336209329 NPI number — KRISTIN STAHL MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KRISTIN STAHL MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336209329
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 UNITED DR
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
COLLINSVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62234-7428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-855-9041
Provider Business Mailing Address Fax Number:
618-855-9046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 UNITED DR
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
COLLINSVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62234-7428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-855-9041
Provider Business Practice Location Address Fax Number:
618-855-9046
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STAHL
Authorized Official First Name:
KRISTIN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
314-833-5437

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X , with the licence number: 036100294 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1202462 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 164815 . This is a "GHP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 412708 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 6032067 . This is a "BCBS OF ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0361002943 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 119414 . This is a "BLUE CHOICE OF MISSOURI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: PC19811 . This is a "CIGNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 205323819 . This is a "205323819" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 7084003 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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