Basic Information
| Provider Information | |||||||||
| NPI: | 1659361673 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | STEWART | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6626 E 75TH ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462502890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176216333 | ||||||||
| FaxNumber: | 3176219676 | ||||||||
| Practice Location | |||||||||
| Address1: | 533 E COUNTY LINE RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461431074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179579050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2005 | ||||||||
| LastUpdateDate: | 09/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 01068195A | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 01031962 | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00004609 | 01 | IN | RAILROAD MEDICARE | OTHER | 000000793087 | 01 | IN | ANTHEM | OTHER | 000000822088 | 01 | IN | ANTHEM | OTHER | 201019410 | 05 | IN | MEDICAID | 100106230A | 05 | IN | MEDICAID | P01291714 | 01 | IN | RAILROAD MEDICARE | OTHER | 100106230 | 05 | IN | MEDICAID |