Healthcare Provider Details

I. General information

NPI: 1689667529
Provider Name (Legal Business Name): KRISTEN M STABELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN DAILL

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PROFESSIONAL DR SUITE 220
ALTON IL
62002-5068
US

IV. Provider business mailing address

PO BOX 959203
SAINT LOUIS MO
63195-9203
US

V. Phone/Fax

Practice location:
  • Phone: 618-463-8610
  • Fax: 618-463-8688
Mailing address:
  • Phone: 618-463-8500
  • Fax: 618-433-6792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number03069334
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number036-069334
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: