Healthcare Provider Details

I. General information

NPI: 1215371950
Provider Name (Legal Business Name): JAMES STEWARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 N HAGGERTY RD
CANTON MI
48187-3795
US

IV. Provider business mailing address

2050 N HAGGERTY RD STE B1
CANTON MI
48187-3795
US

V. Phone/Fax

Practice location:
  • Phone: 734-595-1166
  • Fax:
Mailing address:
  • Phone: 734-595-1166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301501429
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: