Healthcare Provider Details

I. General information

NPI: 1114115268
Provider Name (Legal Business Name): LINDA T STEWART MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4926 S CHAMPLAIN AVE
CHICAGO IL
60615-2541
US

IV. Provider business mailing address

PO BOX 11426
MERRILLVILLE IN
46411-1426
US

V. Phone/Fax

Practice location:
  • Phone: 773-908-0139
  • Fax:
Mailing address:
  • Phone: 773-908-0139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number01044906
License Number StateIN

VIII. Authorized Official

Name: DR. LINDA T STEWART
Title or Position: OWNER
Credential: M.D.
Phone: 773-908-0139