Healthcare Provider Details

I. General information

NPI: 1609780089
Provider Name (Legal Business Name): CHRISTOPHER MATTHEW STODOLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 ALGOMA BLVD
OSHKOSH WI
54901
US

IV. Provider business mailing address

431 MARION RD APT 104
OSHKOSH WI
54901-4728
US

V. Phone/Fax

Practice location:
  • Phone: 920-424-1234
  • Fax:
Mailing address:
  • Phone: 715-651-2383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: