Healthcare Provider Details

I. General information

NPI: 1215082813
Provider Name (Legal Business Name): STEVEN E STOLLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 NW 5TH ST SUITE 100
RICHMOND IN
47374-1844
US

IV. Provider business mailing address

1528 NW 5TH ST SUITE 100
RICHMOND IN
47374-1844
US

V. Phone/Fax

Practice location:
  • Phone: 765-935-0070
  • Fax: 765-935-0073
Mailing address:
  • Phone: 765-935-0070
  • Fax: 765-935-0073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01024995A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number01024995A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: