Provider Demographics
NPI:1942369145
Name:STAHL, KRISTIN V (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:V
Last Name:STAHL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:101 UNITED DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-7428
Mailing Address - Country:US
Mailing Address - Phone:618-855-9041
Mailing Address - Fax:618-855-9046
Practice Address - Street 1:101 UNITED DR
Practice Address - Street 2:SUITE 110
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-7428
Practice Address - Country:US
Practice Address - Phone:618-855-9041
Practice Address - Fax:618-855-9046
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2021-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0361002942080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6032067OtherBC BS OF ILLINOIS FEDERAL
IL050558664OtherGREAT WEST
IL6032067OtherALLIANCE CHOICE
IL1202462OtherUNITED HEALTHCARE
IL412708OtherHEALTHLINK
IL7084003OtherAETNA
IL036100294-3Medicaid
IL164815OtherGHP HMO
IL6032067OtherBC BS OF ILLINOIS
ILPC19811OtherCIGNA
IL164815OtherGHP OPEN ACCESS
IL205323819OtherMISSOURI MEDICAID
IL205323819OtherMISSOURI MEDICAID
IL6032067OtherALLIANCE CHOICE