Healthcare Provider Details

I. General information

NPI: 1841627361
Provider Name (Legal Business Name): MICHAEL EDWIN STOLL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2013
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 EAST MEDICAL CENTER DR B1 FLOOR UNIVERSITY HOSPITAL RECP EMERGENCY
ANN ARBOR MI
48109-5301
US

IV. Provider business mailing address

1 FORD PL
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-6666
  • Fax:
Mailing address:
  • Phone: 313-874-4806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601006768
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006768
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: