Healthcare Provider Details

I. General information

NPI: 1225254915
Provider Name (Legal Business Name): ANITA A. STEWART M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W 154TH ST
HARVEY IL
60426-3552
US

IV. Provider business mailing address

636 W 95TH ST
CHICAGO IL
60628-1065
US

V. Phone/Fax

Practice location:
  • Phone: 708-339-6095
  • Fax: 708-596-2258
Mailing address:
  • Phone: 773-224-7149
  • Fax: 708-596-2258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: