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General NPI Number Information
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NPI Number | 1568459451
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Entity Type | Individual
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Provider Name | MARK L STILLWELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/05/2005
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 6801 ROGERS AVE FL 5
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City | FORT SMITH
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State | AR
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Zip | 72903-4067
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Country | US
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Telephone | 479-274-4100
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Fax | 479-274-4199
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Provider Business Mailing Address
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Address Line | PO BOX 776084
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City | CHICAGO
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State | IL
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Zip | 60677-6084
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Country | US
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Telephone | 479-284-4100
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Fax | 314-364-6321
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | N7411
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License Number State | AR
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