Provider Demographics
NPI:1205024353
Name:W ALLEN STOLER DPM PC
Entity Type:Organization
Organization Name:W ALLEN STOLER DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:STOLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-626-5830
Mailing Address - Street 1:30335 W 13 MILE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2262
Mailing Address - Country:US
Mailing Address - Phone:248-626-5830
Mailing Address - Fax:
Practice Address - Street 1:30335 W 13 MILE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2262
Practice Address - Country:US
Practice Address - Phone:248-626-5830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000456261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1022970Medicaid
MI11289790OtherCAQH
MI1022970Medicaid
MI0P02870Medicare PIN