Healthcare Provider Details

I. General information

NPI: 1043253008
Provider Name (Legal Business Name): JOHN CHARLES STEWART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 W SYCAMORE ST
KOKOMO IN
46901-4113
US

IV. Provider business mailing address

4507 ROLLARD DR.
KOKOMO IN
46902
US

V. Phone/Fax

Practice location:
  • Phone: 765-456-5900
  • Fax: 765-456-5815
Mailing address:
  • Phone: 765-455-9758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01022354A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: