MEDICARE: JANIECE N STEWART M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RS0010X	Sports Medicine (Internal Medicine) Physician	2019014134	MO

General Provider Information

NPI Number	:	1841392651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANIECE N STEWART M.D.

Provider Business Mailing Address
First Line	:	4255 LACLEDE AVE STE A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2814
Country	:	US
Telephone Number	:	314-257-0060
Fax Number	:	314-912-0208

Provider Business Practice Location Address
First Line	:	4255 LACLEDE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2814
Country	:	US
Telephone Number	:	314-257-0060
Fax Number	:	314-912-0208

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	02/25/2026

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