Healthcare Provider Details

I. General information

NPI: 1952219701
Provider Name (Legal Business Name): BROOKE ELIZABETH-CLUTE STEWART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 E CEDAR AVE
GLADWIN MI
48624-2215
US

IV. Provider business mailing address

6392 E COLONVILLE RD
CLARE MI
48617-9790
US

V. Phone/Fax

Practice location:
  • Phone: 989-426-9295
  • Fax:
Mailing address:
  • Phone: 989-506-6077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: