Provider Demographics
NPI:1609868108
Name:STABELL, ERIK CHRISTIAN (MD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:CHRISTIAN
Last Name:STABELL
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 1:1 PROFESSIONAL DR SUITE 220
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-5068
Mailing Address - Country:US
Mailing Address - Phone:618-463-8500
Mailing Address - Fax:618-463-8688
Practice Address - Street 1:1 PROFESSIONAL DR
Practice Address - Street 2:SUITE 220
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5068
Practice Address - Country:US
Practice Address - Phone:618-463-8610
Practice Address - Fax:618-463-8688
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-069182207RI0200X, 207R00000X
MOR6N20207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036069182Medicaid
MO207945908Medicaid
IL207219OtherPTAN
MO207945908Medicaid
MO207945908Medicaid