Provider Demographics
NPI:1417964610
Name:STILLE, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:STILLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 SAHARA TRL
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3667
Mailing Address - Country:US
Mailing Address - Phone:330-758-9787
Mailing Address - Fax:330-758-9792
Practice Address - Street 1:904 SAHARA TRL
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-3667
Practice Address - Country:US
Practice Address - Phone:330-758-9787
Practice Address - Fax:330-758-9792
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35065923208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1900534OtherUNITED HEALTHCARE
GA340013455OtherPALMETTO GBA RAILROAD MED
OH1900448OtherUNITED HEALTHCARE
OH000000137272OtherANTHEM
PAST964034OtherHIGHMARK
OH83079OtherQUALCHOICE
OH1900447OtherUNITED HEALTHCARE
OH2009285Medicaid
G47757Medicare UPIN
OH2009285Medicaid
PAST964034OtherHIGHMARK
OHST08211661Medicare PIN