Healthcare Provider Details

I. General information

NPI: 1316901200
Provider Name (Legal Business Name): THOMAS D STEWART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 N WALNUT ST
HARTFORD CITY IN
47348-1365
US

IV. Provider business mailing address

2005 N WALNUT ST
HARTFORD CITY IN
47348-1365
US

V. Phone/Fax

Practice location:
  • Phone: 765-348-1100
  • Fax: 765-348-9717
Mailing address:
  • Phone: 765-348-1100
  • Fax: 765-348-9717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01058047A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: