Provider Demographics
NPI:1427003573
Name:STILLSON, TOD ALAN (MD)
Entity type:Individual
Prefix:
First Name:TOD
Middle Name:ALAN
Last Name:STILLSON
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 1:1000 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-2326
Mailing Address - Country:US
Mailing Address - Phone:620-241-2250
Mailing Address - Fax:620-798-2630
Practice Address - Street 1:1000 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-2326
Practice Address - Country:US
Practice Address - Phone:620-241-2250
Practice Address - Fax:620-798-2630
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046800207Q00000X
KS04-50400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200144530AMedicaid
IN1102361024OtherANTHEM
IN021236800OtherFEDERAL BLACK LUNG
IN187730AMedicare PIN
IN021236800OtherFEDERAL BLACK LUNG
IN000000216169OtherBCBS