Healthcare Provider Details

I. General information

NPI: 1316922255
Provider Name (Legal Business Name): SONJA R STILLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 MENTOR AVE
MENTOR OH
44060-7522
US

IV. Provider business mailing address

7200 MENTOR AVE
MENTOR OH
44060-7522
US

V. Phone/Fax

Practice location:
  • Phone: 440-710-1140
  • Fax:
Mailing address:
  • Phone: 440-710-1140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number350745225
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35074522S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: