Healthcare Provider Details

I. General information

NPI: 1730129503
Provider Name (Legal Business Name): M. THOMAS STILLMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PARK AVE R7
MINNEAPOLIS MN
55415-1623
US

IV. Provider business mailing address

701 PARK AVE
MINNEAPOLIS MN
55415-1623
US

V. Phone/Fax

Practice location:
  • Phone: 612-873-2300
  • Fax: 612-904-4358
Mailing address:
  • Phone: 612-873-8723
  • Fax: 612-904-4263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number16985
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: