Healthcare Provider Details

I. General information

NPI: 1891704797
Provider Name (Legal Business Name): AILEEN G STILLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 STATE ST
LA PORTE IN
46350-3115
US

IV. Provider business mailing address

PO BOX 1690
LA PORTE IN
46352-1690
US

V. Phone/Fax

Practice location:
  • Phone: 219-326-5700
  • Fax: 219-326-8131
Mailing address:
  • Phone: 219-326-2312
  • Fax: 219-326-2584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01022876A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: