Provider Demographics
NPI:1578613014
Name:STOTLER, MICHAEL BRENT (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRENT
Last Name:STOTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5500 HEEGE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-3505
Mailing Address - Country:US
Mailing Address - Phone:314-351-0550
Mailing Address - Fax:314-962-2538
Practice Address - Street 1:5500 HEEGE RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-3505
Practice Address - Country:US
Practice Address - Phone:314-351-0550
Practice Address - Fax:314-962-2538
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1108462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI205032105Medicaid
H20021Medicare UPIN
MI004012687Medicare ID - Type Unspecified