Provider Demographics
NPI:1467109231
Name:STILLSON, QUINN ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:QUINN
Middle Name:ANDREW
Last Name:STILLSON
Suffix:
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 1:1004 PARKWAY AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-9349
Mailing Address - Country:US
Mailing Address - Phone:574-294-1883
Mailing Address - Fax:
Practice Address - Street 1:1004 PARKWAY AVE STE C
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-9349
Practice Address - Country:US
Practice Address - Phone:574-294-1883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01094239A202D00000X
IL125081732207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine