Healthcare Provider Details

I. General information

NPI: 1205805579
Provider Name (Legal Business Name): MARK C STEWART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 COLUMBUS AVE STE 360
BAY CITY MI
48708-6476
US

IV. Provider business mailing address

4 COLUMBUS AVE STE 360
BAY CITY MI
48708-6476
US

V. Phone/Fax

Practice location:
  • Phone: 989-894-1111
  • Fax: 989-894-2994
Mailing address:
  • Phone: 989-894-1111
  • Fax: 989-894-2994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberMS043841
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: