MEDICARE: MARK L STILLWELL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	N7411	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568459451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK L STILLWELL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 776084
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6084
Country	:	US
Telephone Number	:	479-284-4100
Fax Number	:	314-364-6321

Provider Business Practice Location Address
First Line	:	6801 ROGERS AVE FL 5
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-4067
Country	:	US
Telephone Number	:	479-274-4100
Fax Number	:	479-274-4199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	10/18/2024

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