Provider Demographics
NPI:1932389111
Name:STOLL, JANIS MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANIS
Middle Name:MARIE
Last Name:STOLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-454-6173
Mailing Address - Fax:844-231-8912
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV PED GASTRO, HEPATOLOGY AND NUTRITION
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6173
Practice Address - Fax:844-231-8912
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2012035764208000000X, 2080T0004X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080T0004XAllopathic & Osteopathic PhysiciansPediatricsPediatric Transplant Hepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200001624Medicaid
MO1932389111Medicaid