Healthcare Provider Details

I. General information

NPI: 1346695988
Provider Name (Legal Business Name): KURT EDWARD STOLL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W 5TH AVE STE 500
SPOKANE WA
99204-2756
US

IV. Provider business mailing address

601 W 5TH AVE STE 400
SPOKANE WA
99204-2715
US

V. Phone/Fax

Practice location:
  • Phone: 509-344-8672
  • Fax: 509-747-7838
Mailing address:
  • Phone: 509-344-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number76420
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: