Provider Demographics
NPI:1396746319
Name:STOLER, WILLIAM A (DPM)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:STOLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:W
Other - Middle Name:ALLEN
Other - Last Name:STOLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:30335 W 13 MILE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2262
Mailing Address - Country:US
Mailing Address - Phone:248-626-5830
Mailing Address - Fax:
Practice Address - Street 1:30335 W 13 MILE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2262
Practice Address - Country:US
Practice Address - Phone:248-626-5830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000456213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4856301240OtherBCBS
MI1022970Medicaid
11289790OtherCAQH
MI5901000456OtherSTATE LICENSE
MI5901000456OtherSTATE LICENSE
11289790OtherCAQH
T91646Medicare UPIN