MEDICARE: JILLIAN CHRISTINE STALLING MD

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	207V00000X	Obstetrics & Gynecology Physician	6583	KS
2	207V00000X	Obstetrics & Gynecology Physician	01082017A	IN

General Provider Information

NPI Number	:	1659593507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN CHRISTINE STALLING MD

Provider Business Mailing Address
First Line	:	PO BOX 772437
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48277-2437
Country	:	US
Telephone Number	:	317-575-7304
Fax Number	:	317-575-7333

Provider Business Practice Location Address
First Line	:	10228 DUPONT CIRCLE DR E STE 100
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1611
Country	:	US
Telephone Number	:	260-222-7401
Fax Number	:	260-209-5956

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	02/01/2023

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