Provider Demographics
NPI:1154390128
Name:STOLLMEYER, JILL A (DO)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:STOLLMEYER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:DEPT 201
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-6069
Mailing Address - Country:US
Mailing Address - Phone:866-282-7905
Mailing Address - Fax:317-614-9655
Practice Address - Street 1:9202 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1800
Practice Address - Country:US
Practice Address - Phone:317-538-4769
Practice Address - Fax:317-614-9655
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001343207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200098450Medicaid
INF48630Medicare UPIN
IN168040OMedicare PIN
IN145920HMedicare PIN