Provider Demographics
NPI:1568459451
Name:STILLWELL, MARK L (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:STILLWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:479-284-4100
Mailing Address - Fax:314-364-6321
Practice Address - Street 1:6801 ROGERS AVE FL 5
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4067
Practice Address - Country:US
Practice Address - Phone:479-274-4100
Practice Address - Fax:479-274-4199
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2024-10-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARN7411207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR114655001Medicaid
AR100123480AMedicaid
ARB69780Medicare UPIN
AR100123480AMedicaid