1164403523 NPI number — DR. MICHAEL P STEWART MD

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	STEWART
Provider First Name	:	MICHAEL
Provider Middle Name	:	P
Provider Name Prefix Text	:	DR.
Provider Name Suffix Text	:
Provider Credential Text	:	MD
Provider Gender Code	:	M

Provider Other Organization Name	:
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Provider Other Last Name	:
Provider Other First Name	:
Provider Other Middle Name	:
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Provider Other Name Suffix Text	:
Provider Other Credential Text	:
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NPI Number	:	1164403523
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	07/08/2007
NPI Deactivation Reason Code	:
NPI Deactivation Date	:
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Provider First Line Business Mailing Address	:	1011 W BALTIMORE PIKE
Provider Second Line Business Mailing Address	:	SUITE 106
Provider Business Mailing Address City Name	:	WEST GROVE
Provider Business Mailing Address State Name	:	PA
Provider Business Mailing Address Postal Code	:	193909446
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	6103451761
Provider Business Mailing Address Fax Number	:	6103451762

Provider First Line Business Practice Location Address	:	1011 W BALTIMORE PIKE
Provider Second Line Business Practice Location Address	:	SUITE 106
Provider Business Practice Location Address City Name	:	WEST GROVE
Provider Business Practice Location Address State Name	:	PA
Provider Business Practice Location Address Postal Code	:	193909446
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	6103451761
Provider Business Practice Location Address Fax Number	:	6103451762
Provider Enumeration Date	:	11/10/2005

Authorized Official Last Name	:
Authorized Official First Name	:
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• Taxonomy code: 208600000X , with the licence number:  MD018787E , registered in the state of PA .

• Identifier: 116147 , issued by the state of ( PA ) . This identifiers is of the category "".
• Identifier: 1009220910001 , issued by the state of ( PA ) . This identifiers is of the category "".
• Identifier: C30566 , issued by the state of ( PA ) . This identifiers is of the category "".