MEDICARE: WAYNE STILLICK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080N0001X	Neonatal-Perinatal Medicine Physician	2016-01993	NC

General Provider Information

NPI Number	:	1457344285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE STILLICK

Provider Business Mailing Address
First Line	:	1001 BLYTHE BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5866
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 BLYTHE BLVD
Second Line	:	MEDICAL CENTER PLAZA SUITE 200
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5866
Country	:	US
Telephone Number	:	704-381-8840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	10/24/2018

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Directions to “ WAYNE STILLICK ” Practice Location

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