Healthcare Provider Details

I. General information

NPI: 1821156472
Provider Name (Legal Business Name): SEAN D STILTNER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 FAIRWAY AVE
PIKETON OH
45661-9123
US

IV. Provider business mailing address

121 FAIRWAY AVE
PIKETON OH
45661-9123
US

V. Phone/Fax

Practice location:
  • Phone: 740-352-7733
  • Fax:
Mailing address:
  • Phone: 740-352-7733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.008708
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34008708
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: