Provider Demographics
NPI:1376523472
Name:STOLLENWERK, NICHOLAS S (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:S
Last Name:STOLLENWERK
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:4150 V ST STE 3400
Mailing Address - Street 2:DIVISION OF PULMONARY, CRITICAL CARE & SLEEP MEDICINE
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:916-734-3564
Mailing Address - Fax:916-734-7924
Practice Address - Street 1:4150 V ST STE 3400
Practice Address - Street 2:DIVISION OF PULMONARY, CRITICAL CARE & SLEEP MEDICINE
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-3564
Practice Address - Fax:916-734-7924
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2011-12-16
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Provider Licenses
StateLicense IDTaxonomies
CAOOA818000207R00000X, 207RP1001X
CAA818000207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I07537Medicare UPIN