John W Stoulil, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9410 Issued in MN

Practice address

12175 Aberdeen St NE
Blaine, MN 55449-4717

Phone

(763) 785-4200

Fax

(763) 785-3314

NPI assigned

Dec 1, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1104800358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12175 ABERDEEN ST NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554494717",
            "telephone_number": "763-785-4200",
            "fax_number": "763-785-3314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12175 ABERDEEN ST NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554494717",
            "telephone_number": "763-785-4200",
            "fax_number": "763-785-3314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOULIL",
        "first_name": "JOHN",
        "middle_name": "W",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Blaine, MN
• Providers in Blaine, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.