Healthcare Provider Details

I. General information

NPI: 1407269822
Provider Name (Legal Business Name): EMILY SUZANNE STOLL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15855 19 MILE RD
CLINTON TOWNSHIP MI
48038-3504
US

IV. Provider business mailing address

PO BOX 670884
DETROIT MI
48267-0884
US

V. Phone/Fax

Practice location:
  • Phone: 248-652-5000
  • Fax: 313-876-1305
Mailing address:
  • Phone: 800-999-5829
  • Fax: 248-641-4840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006988
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: