Basic Information
| Provider Information | |||||||||
| NPI: | 1831157593 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STOLL | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 315 E BROADWAY | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026292500 | ||||||||
| FaxNumber: | 5026293166 | ||||||||
| Practice Location | |||||||||
| Address1: | 4001 DUTCHMANS LN | ||||||||
| Address2: | SUITE G02 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028996601 | ||||||||
| FaxNumber: | 5028996644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 01/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 26258 | KY | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 200071510 | 05 | IN | MEDICAID | 2556442 | 01 | KY | CIGNA PROVIDER NUMB | OTHER | 920005752 | 01 | KY | RAILROAD MEDICARE | OTHER | 5045158 | 01 | KY | AETNA PROVIDER NUMB | OTHER | 64262587 | 05 | KY | MEDICAID | 000000111402 | 01 | KY | ANTHEM PROVIDER NUMB | OTHER | 000020583I | 01 | KY | HUMANA PROVIDER NUMB | OTHER | 1118182 | 01 | KY | PASSPORT PROVIDER NUMB | OTHER |