Healthcare Provider Details

I. General information

NPI: 1801109947
Provider Name (Legal Business Name): STEWARD MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 WARREN ST
BRIGHTON MA
02135-3601
US

IV. Provider business mailing address

77 WARREN ST
BRIGHTON MA
02135-3601
US

V. Phone/Fax

Practice location:
  • Phone: 615-467-4158
  • Fax: 615-467-1267
Mailing address:
  • Phone: 617-562-5359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J CALLUM
Title or Position: CEO OF STEWARD PHYSICIAN NETWORK
Credential: MD
Phone: 617-779-6303