Healthcare Provider Details

I. General information

NPI: 1548245244
Provider Name (Legal Business Name): CHRISTAN STEWART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 HWY 227
CARROLLTON KY
41008-8037
US

IV. Provider business mailing address

1613 KAMER DR
LA GRANGE KY
40031-8601
US

V. Phone/Fax

Practice location:
  • Phone: 502-287-6725
  • Fax: 502-732-8553
Mailing address:
  • Phone: 502-802-5984
  • Fax: 502-732-8553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number32540
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: