Healthcare Provider Details

I. General information

NPI: 1578674420
Provider Name (Legal Business Name): DAVID W STOLTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/05/2024
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13700 OLD STATE RD
CHARLESTON IL
61920-7684
US

IV. Provider business mailing address

13700 OLD STATE RD
CHARLESTON IL
61920-7684
US

V. Phone/Fax

Practice location:
  • Phone: 217-345-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-089583
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: