Provider Demographics
NPI:1427003573
Name:STILLSON, TOD ALAN (MD)
Entity Type:Individual
Prefix:
First Name:TOD
Middle Name:ALAN
Last Name:STILLSON
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 1:707 CEDAR ST STE 405
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2059
Mailing Address - Country:US
Mailing Address - Phone:745-335-8707
Mailing Address - Fax:574-335-0741
Practice Address - Street 1:209 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-1861
Practice Address - Country:US
Practice Address - Phone:574-948-5100
Practice Address - Fax:574-335-0745
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200144530AMedicaid
IN1102361024OtherANTHEM
IN021236800OtherFEDERAL BLACK LUNG
IN187730AMedicare PIN
IN021236800OtherFEDERAL BLACK LUNG
IN000000216169OtherBCBS