Provider Demographics
NPI:1700806254
Name:STILSON, SHIRLEY ANA (MD)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ANA
Last Name:STILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:ANA
Other - Last Name:MATHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:800 W CENTRAL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2349
Mailing Address - Country:US
Mailing Address - Phone:877-635-9229
Mailing Address - Fax:847-618-3259
Practice Address - Street 1:6336 MARTIN DR
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5328
Practice Address - Country:US
Practice Address - Phone:949-370-7225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93448207R00000X
IL036108964207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA93448OtherMEDICAL LICENSE
IL036-108964OtherMEDICAL LICENSE