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Individual
DR. STONEWALL MCCUISTON JR.
Active
Individual
DR. STONEWALL MCCUISTON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036074737
IL
208000000X
Pediatrics Physician
Primary
036074737
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036074737
—
IL
01
—
4623239
BLUE CROSS AND BLUE SHIELD OF ILLINOIS
IL
Enumeration date
08/31/2005
Last updated
03/29/2021
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