Provider Demographics
NPI:1215082813
Name:STOLLER, STEVEN E (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:E
Last Name:STOLLER
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 1:1528 NW 5TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1844
Mailing Address - Country:US
Mailing Address - Phone:765-935-0070
Mailing Address - Fax:765-935-0073
Practice Address - Street 1:1528 NW 5TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1844
Practice Address - Country:US
Practice Address - Phone:765-935-0070
Practice Address - Fax:765-935-0073
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024995A207W00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100256210Medicaid
INE03894Medicare UPIN
IN235370AMedicare ID - Type Unspecified
IN100256210Medicaid
INE03894Medicare UPIN
INP00948128OtherMEDICARE ID
IN100256210Medicaid
IN200835270Medicaid