Provider Demographics
NPI:1447292875
Name:STOLKER, JOSHUA M (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:M
Last Name:STOLKER
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 1:901 PATIENTS FIRST DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-4700
Mailing Address - Country:US
Mailing Address - Phone:636-239-2711
Mailing Address - Fax:636-239-3385
Practice Address - Street 1:901 PATIENTS FIRST DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4700
Practice Address - Country:US
Practice Address - Phone:636-239-2711
Practice Address - Fax:636-239-3385
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001024953207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209299908Medicaid
MOP01365370OtherRAILROAD MEDICARE
MOP01365370OtherRAILROAD MEDICARE
000093029Medicare PIN
917202057Medicare PIN
I04379Medicare UPIN
MOMA1160050Medicare PIN