Healthcare Provider Details

I. General information

NPI: 1588200596
Provider Name (Legal Business Name): DR. MARK ARTHUR STILLWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 LINCOLN HWY W
NEW HAVEN IN
46774-2139
US

IV. Provider business mailing address

821 LINCOLN HWY W
NEW HAVEN IN
46774-2139
US

V. Phone/Fax

Practice location:
  • Phone: 260-749-0215
  • Fax: 260-749-1166
Mailing address:
  • Phone: 260-749-0215
  • Fax: 260-749-6180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number26019379A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: