Healthcare Provider Details

I. General information

NPI: 1457325839
Provider Name (Legal Business Name): MICHAEL ALLEN STILLMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BEDFORD RD
KATONAH NY
10536-2115
US

IV. Provider business mailing address

111 BEDFORD RD
KATONAH NY
10536-2115
US

V. Phone/Fax

Practice location:
  • Phone: 914-232-3135
  • Fax: 914-242-1516
Mailing address:
  • Phone: 914-232-3135
  • Fax: 914-242-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number1012341
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number1012341
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: