Provider Demographics
NPI:1598170961
Name:STODOLA, LEVI A (MD)
Entity Type:Individual
Prefix:DR
First Name:LEVI
Middle Name:A
Last Name:STODOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2031 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-5181
Mailing Address - Country:US
Mailing Address - Phone:715-423-0122
Mailing Address - Fax:715-422-6460
Practice Address - Street 1:2031 PEACH ST
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-5181
Practice Address - Country:US
Practice Address - Phone:715-423-0122
Practice Address - Fax:715-422-6460
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI64656-20207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine