Provider Demographics
NPI:1184790214
Name:STILSON, MICHAEL RALPH (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RALPH
Last Name:STILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 E LOWELL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85721-0001
Mailing Address - Country:US
Mailing Address - Phone:520-626-6363
Mailing Address - Fax:520-626-2416
Practice Address - Street 1:1224 E LOWELL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0001
Practice Address - Country:US
Practice Address - Phone:520-626-6363
Practice Address - Fax:520-626-2416
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ177092080S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine