Provider Demographics
NPI:1831466085
Name:DON F. STALLMAN MD
Entity Type:Organization
Organization Name:DON F. STALLMAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:F
Authorized Official - Last Name:STALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-347-2854
Mailing Address - Street 1:409 E WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:KENDALLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46755-1459
Mailing Address - Country:US
Mailing Address - Phone:260-347-2854
Mailing Address - Fax:260-347-3863
Practice Address - Street 1:409 E WAYNE ST
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-1459
Practice Address - Country:US
Practice Address - Phone:260-347-2854
Practice Address - Fax:260-347-3863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027870207L00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
108772OtherBLACK LUNG
P00011664OtherRAILROAD
4105386OtherAETNA
IN100190840Medicaid
1892OtherPHP
0000000258973OtherANTHEM BC-REG
0000000282834OtherANTHEM BCBS
312507650OtherCIGNA
070860XMedicare PIN
B29224Medicare UPIN