Healthcare Provider Details

I. General information

NPI: 1700163045
Provider Name (Legal Business Name): SEAN STILTNER, D.O.,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 FAIRWAY AVE
PIKETON OH
45661-9123
US

IV. Provider business mailing address

715 W EMMITT AVE
WAVERLY OH
45690-1015
US

V. Phone/Fax

Practice location:
  • Phone: 740-352-7733
  • Fax:
Mailing address:
  • Phone: 740-947-8000
  • Fax: 740-947-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SEAN DUANE STILTNER
Title or Position: MEMBER
Credential: D.O.
Phone: 740-352-7733