Basic Information
| Provider Information | |||||||||
| NPI: | 1891916219 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STAMPEHL | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 619 E MASON ST | ||||||||
| Address2: | SUITE 4P57 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627011034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177880706 | ||||||||
| FaxNumber: | 2177449119 | ||||||||
| Practice Location | |||||||||
| Address1: | 1605 E BROADWAY STE 300 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652018023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5732567700 | ||||||||
| FaxNumber: | 5732563003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 09/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | M5520 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 036.128842 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | P01036842 | 01 | IL | RAILROAD | OTHER | 036128842 | 05 | IL | MEDICAID |