Healthcare Provider Details

I. General information

NPI: 1730407172
Provider Name (Legal Business Name): CAMILLE LINICK STEWART MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PARK CENTRAL DR
HIGHLANDS RANCH CO
80129-6688
US

IV. Provider business mailing address

PO BOX 110429
AURORA CO
80042-0429
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberDR.0057227
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: