Healthcare Provider Details

I. General information

NPI: 1710642814
Provider Name (Legal Business Name): STEWARD MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 SEMINOLE DR
ROCKLEDGE FL
32955-2836
US

IV. Provider business mailing address

9 GALEN ST FL 1
WATERTOWN MA
02472-4515
US

V. Phone/Fax

Practice location:
  • Phone: 321-637-2975
  • Fax:
Mailing address:
  • Phone: 617-562-5628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY MARIE GUAY
Title or Position: PRESIDENT OF SMG
Credential:
Phone: 617-562-7070