Basic Information
| Provider Information | |||||||||
| NPI: | 1144229238 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEWART | ||||||||
| FirstName: | DAN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 SIERRA DRIVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461437241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175284284 | ||||||||
| FaxNumber: | 3178658355 | ||||||||
| Practice Location | |||||||||
| Address1: | 1630 LAFAYETTE RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | CRAWFORDSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479331090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7653611234 | ||||||||
| FaxNumber: | 7653612267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2005 | ||||||||
| LastUpdateDate: | 06/12/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 01071006A | IN | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 201088910 | 05 | IN | MEDICAID | M471400004 | 01 | IN | MEDICARE PROVIDER PTAN | OTHER |