Provider Demographics
NPI:1336209329
Name:KRISTIN STAHL MD PC
Entity type:Organization
Organization Name:KRISTIN STAHL MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-833-5437
Mailing Address - Street 1:101 UNITED DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-7428
Mailing Address - Country:US
Mailing Address - Phone:618-855-9041
Mailing Address - Fax:618-855-9046
Practice Address - Street 1:101 UNITED DR
Practice Address - Street 2:SUITE 110
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-7428
Practice Address - Country:US
Practice Address - Phone:618-855-9041
Practice Address - Fax:618-855-9046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208000000X
IL036100294261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1202462OtherUNITED HEALTHCARE
IL164815OtherGHP
IL412708OtherHEALTHLINK
IL6032067OtherBCBS OF ILLINOIS
IL0361002943Medicaid
IL119414OtherBLUE CHOICE OF MISSOURI
ILPC19811OtherCIGNA
IL205323819Other205323819
IL7084003OtherAETNA
ILL090471Medicare ID - Type Unspecified
IL6032067OtherBCBS OF ILLINOIS