Provider Demographics
NPI:1659304343
Name:STILP, SONJA KIRSTEN (MD)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:KIRSTEN
Last Name:STILP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 ARAPAHOE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-9102
Mailing Address - Country:US
Mailing Address - Phone:303-448-8843
Mailing Address - Fax:303-635-6859
Practice Address - Street 1:311 MAPLETON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3979
Practice Address - Country:US
Practice Address - Phone:303-448-8843
Practice Address - Fax:303-635-6859
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO418022081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO45003572Medicaid
COC805056Medicare ID - Type Unspecified
COH99371Medicare UPIN