Basic Information
| Provider Information | |||||||||
| NPI: | 1215500285 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEWARD MEDICAL GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 GALEN ST | ||||||||
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| City: | WATERTOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024724515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175625628 | ||||||||
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| Practice Location | |||||||||
| Address1: | 240 N WICKHAM RD STE 300 | ||||||||
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| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329358661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217521588 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2021 | ||||||||
| LastUpdateDate: | 07/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | GUAY | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT OF STEWARD MEDICAL GROUP | ||||||||
| AuthorizedOfficialTelephone: | 6175625628 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.