Provider Demographics
NPI:1225691090
Name:GEOFFREY STILLER MD PS
Entity Type:Organization
Organization Name:GEOFFREY STILLER MD PS
Other - Org Name:STILLER AESTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:STILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-747-5773
Mailing Address - Street 1:805 W 5TH AVE STE 619
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2802
Mailing Address - Country:US
Mailing Address - Phone:509-747-5773
Mailing Address - Fax:509-960-4063
Practice Address - Street 1:805 W 5TH AVE STE 619
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2802
Practice Address - Country:US
Practice Address - Phone:509-998-1865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2128848Medicaid