Provider Demographics
NPI:1750360608
Name:STOHLE, MICHAEL R (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:STOHLE
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:500 DAVIS ST
Mailing Address - Street 2:STE 509
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201
Mailing Address - Country:US
Mailing Address - Phone:847-869-9303
Mailing Address - Fax:847-869-9323
Practice Address - Street 1:500 DAVIS ST
Practice Address - Street 2:STE 509
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-869-9303
Practice Address - Fax:847-869-9323
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
661860Medicare ID - Type Unspecified
T37590Medicare UPIN