Individual
DR. LEVI A STODOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1565 ALLOUEZ AVE, GREEN BAY, WI 54311-5639
(920) 468-2400
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
64656-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100048729
—
WI
Enumeration date
06/24/2014
Last updated
10/16/2024
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