Healthcare Provider Details

I. General information

NPI: 1356861504
Provider Name (Legal Business Name): DANIEL STEWART DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3659 S MIAMI AVE STE 3008
MIAMI FL
33133-4225
US

IV. Provider business mailing address

90 SW 3RD ST APT 1608
MIAMI FL
33130-4021
US

V. Phone/Fax

Practice location:
  • Phone: 305-859-7777
  • Fax:
Mailing address:
  • Phone: 305-244-9853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPR505
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: