Healthcare Provider Details

I. General information

NPI: 1255600300
Provider Name (Legal Business Name): STEWARD MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BOYLSTON ST
BOSTON MA
02116-3740
US

IV. Provider business mailing address

500 BOYLSTON ST
BOSTON MA
02116-3740
US

V. Phone/Fax

Practice location:
  • Phone: 615-467-4158
  • Fax: 615-467-1267
Mailing address:
  • Phone: 617-419-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL CALLUM
Title or Position: CEO
Credential:
Phone: 617-419-4702