MEDICARE: JAMES EDWIN STOLL JR. MD

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	207X00000X	Orthopaedic Surgery Physician	26052	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00707813	OTHER	WI	RR MEDICARE

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

General Provider Information

NPI Number	:	1790713527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES EDWIN STOLL JR. MD

Provider Business Mailing Address
First Line	:	611 E LAKE HILL CT
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53217-4351
Country	:	US
Telephone Number	:	414-962-4645
Fax Number	:	339-207-0541

Provider Business Practice Location Address
First Line	:	525 W RIVER WOODS PKWY STE 240
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53212-1010
Country	:	US
Telephone Number	:	414-807-6128
Fax Number	:	339-207-0541

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	02/27/2021

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