Healthcare Provider Details

I. General information

NPI: 1427621713
Provider Name (Legal Business Name): STEWARD MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 07/23/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 W 20TH AVE STE 615
HIALEAH FL
33016-5511
US

IV. Provider business mailing address

9 GALEN ST
WATERTOWN MA
02472-4515
US

V. Phone/Fax

Practice location:
  • Phone: 305-820-6657
  • Fax:
Mailing address:
  • Phone: 617-562-5628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY MARIE GUAY
Title or Position: PROVIDER ENROLLMENT MANAGER
Credential:
Phone: 617-562-5628