Provider Demographics
NPI:1790713527
Name:STOLL, JAMES EDWIN JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWIN
Last Name:STOLL
Suffix:JR
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 1:611 E LAKE HILL CT
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4351
Mailing Address - Country:US
Mailing Address - Phone:414-962-4645
Mailing Address - Fax:339-207-0541
Practice Address - Street 1:525 W RIVER WOODS PKWY STE 240
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212-1010
Practice Address - Country:US
Practice Address - Phone:414-807-6128
Practice Address - Fax:339-207-0541
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26052207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30590700Medicaid
WIP00707813OtherRR MEDICARE
WI30590700Medicaid
WIP00707813OtherRR MEDICARE
B56907Medicare UPIN