Mark J Stout
Transplant Surgeon Cardiothoracic Vascular Surgeon
725 American Ave
Waukesha
, Wisconsin 53188-5031
Mark J Stout
Transplant Surgeon Cardiothoracic Vascular Surgeon
725 American Ave
Waukesha
, Wisconsin 53188-5031
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About
Features
Specialties
- Transplant Surgeon
- Cardiothoracic Vascular Surgeon
Languages spoken
- English
Location
First Address
- Mark J Stout
- 725 American Ave
- Waukesha, WI
- Zip : 53188-5031
- Phone :
Second Address
- Mark J Stout
- 725 American Ave
- Waukesha, WI
- Zip : 53188-5031
- Phone : (608) 263-1530
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 204F00000X | Transplant Surgeon | 62383 | WI |
| N | 208G00000X | Cardiothoracic Vascular Surgeon | 01069517A | IN |
| N | 208G00000X | Cardiothoracic Vascular Surgeon | 036080105 | IL |
| N | 208G00000X | Cardiothoracic Vascular Surgeon | 62383 | WI |
National Provider Identifier
| NPI | 1851386551 |
|---|---|
| Provider Name | Mark J Stout |
| First Address | Waukesha, WI 53188-5031 |
| Second Address | Waukesha, WI 53188-5031 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 19/09/2005 |
| Last Update Date | 03/05/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 000001005823 | ANTHEM PROVIDER NUMBER FOR TIN 35-2030653 (01) | IN |
| 01605360 | BCBS PROVIDER ID (01) | IL |
| 036080105 | (05) | IL |
| 201019900 | (05) | IN |
| 780000280 | RAILROAD MEDICARE (01) | IL |
| F28512 | (02) | IL |
| P01027332 | RAILROAD MEDICARE (01) | IN |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.